Dr S Mann v The Helios Trust and Dr F Mulder and Mr R Laver T/a Helios Medical Centre: 1404530/2019
EMPLOYMENT TRIBUNALS
Case No 1404530/2019
Between
Dr S MannClaimantThe Helios Trust and Dr F Mulder and Mr R Laver T/a Helios Medical CentreRespondent
Before
Employment Judge GorajDate 3 May 2022
JUDGMENT
[1]The complaint against the First Respondent, The Helios Trust, is dismissed following a withdrawal by the claimant. The claimant’s remaining claims will proceed to hearings listed on 2 February 2021 and 1-5 March 2021. JUDGMENT[2]The Claimant’s claim in respect of unfair constructive dismissal, including automatically unfair constructive dismissal contrary to section 103A of the Employment Rights Act 1996, for detriment on the ground of protected disclosures contrary to section 47B of that Act and for breach of contract succeed. The hearing is adjourned for a hearing on remedy and other matters, including the outstanding claims, with a preliminary hearing by telephone listed for 13 April 2021 at 2pm, as separately notified to the parties. At the request of the Claimant following the oral judgment given on 5 March 2021, written Reasons are also to be issued.
REASONS
Findings
[1]Evidence 1.1. The Tribunal heard from Dr Sonia Mann, the claimant, from Ms Dagma Friis Operations Manager, Mr Richard Laver, managing partner, Dr Frank Mulder, clinical partner. Witness statements were provided from Dr Cuellar and Dr Tulloh but they did not attend. 1.2. The Tribunal read the documents in the bundle referred to.[2]Issues 2.1. The claimant claims constructive unfair dismissal, automatic constructive unfair dismissal contrary to section 103A of the Employment Rights Act 1996 (“ERA 1996”) and detriment due to making protected disclosures contrary to section 47B, with breach of contract (wrongful dismissal) and detriment and / or and automatic constructive unfair dismissal pursuant to sections 44 and 100 of the ERA 1996 (health and safety grounds). The Respondent defended all claims. 2.2. The issues before the Tribunal to decide are as follows. These were set out in the Order of Employment Judge Goraj on 1 April 2020. A numbering error at paragraph 4.1.1 of the original Order has been corrected. Constructive Unfair Dismissal 2.3. The Claimant claims that the Respondents acted in fundamental breach of contract in respect of the express/implied term of her contract relating to pay/mutual trust and confidence. The alleged breach(es) were as follow: - 2.3.1. From 26 April 2019 onwards, failing to provide safe systems of work / creating risk of harm to Claimant and/or patients. The Claimant relies on the following alleged matters: -(a)26 April 2019 and/or 1 May 2019 – booking routine appointments into triage clinic(b)7 June 2019 – email from Claimant to the Respondents regarding inadequate time to perform administrative duties(c)11 June 2019 email and WhatsApp message to Respondents raising concerns relating to patient safety and inadequate levels of GP cover(d)12 June 2019 – email to the Respondents raising safety concerns relating to lack of triage provision(e)12 June 2019 – the matters referred to in the Claimant’s grievance to the Respondents(f)12 June 2019 – WhatsApp message to Mr Laver in which the Claimant raised concerns regarding alleged crisis situation in patient safety and(g)12 June 2019 – alleged inappropriate conduct by Ms D Friis 2.3.2. From 26 April 2019 onwards failing to provide safe systems of work thereby creating additional stress to the Claimant and risk of harm to patients. The Claimant relies on the following alleged failures: - (a) Insufficient GP coverage and (b) Expecting the Claimant to undertake excessive / unsafe levels of work (including expecting the Claimant to cover clinics with pre-booked and emergent patients without any /any sufficient support) creating additional stress to the Claimant and risk of harm to patients. The Claimant relies on the alleged matters referred to at paragraph 2.3.1 above. 2.3.3. 12 June 2019 onwards – causing the Claimant extreme stress resulting in her being off sick on the following dates: - 12 June 2019, 17 June 2019, 21 June 2019 and 4 July 2019. 2.3.4. 12 June 2019 onwards – alleged failure to deal / deal adequately with the Claimant’s grievance dated 12 June 2019. 2.3.5. 3 July 2019 – alleged treatment of the Claimant by Ms Friis 2.3.6. 3 July 2019 – unilateral cancellation of locum shifts without prior consultation / explanation / the Respondent’s decision to challenge the Claimant’s invoice number 37. (The last of those breaches was said to have been the ‘last straw’ in a series of breaches as that concept is recognised in law). 2.4. Did the Claimant resign because of the breach? The Respondents deny that they committed any breaches. 2.5. Did the Claimant delay before resigning and affirm the contract? The Respondents do not rely on any argument of affirmation. 2.6. In the event that there was a constructive dismissal, was it otherwise fair within the meaning of s.98(1), (2) and (4) of the Act? The Respondents contend that if the Claimant was constructively dismissed (which is denied) that (a) The Claimant was fairly dismissed by reason of her conduct and / or that (b) She would, in the event of any procedural defects for the purposes of section 98(4) of the Act have been fairly dismissed if a fair procedure had been followed and /or (c) That the Claimant was, in any event, guilty of contributory conduct (in the light of the Claimant’s conduct). 2.7. The Public Interest disclosure claim/s 2.7.1. What did the Claimant say or write? The Claimant relies on: 11 June 2019 – email and WhatsApp from the claimant to the Respondents dated 11 June 2019 raising concerns regarding patient safety and level of GP cover. 12 June 2019 – further email and WhatsApp from the Claimant to the Respondents raising concerns regarding the level of GP cover 12 June 2019 – the Claimant’s grievance 13 June 2019 – emails from the Claimant to the Respondents raising concerns about alleged excessive levels of stress and responsibility placed upon her by the Respondents 21 June 2019 – WhatsApp message to the Respondents (Mr Laver) regarding the cancellation of triage (doctor first) clinics 2.7.2. In any or all of these, was information disclosed which in the Claimant’s reasonable belief tended to show that: - The health of safety of any individual, including the Claimant, other members of the Respondent’s staff and / or patients had been put at risk as a result of alleged unsafe working practices / understaffing operated by the Respondents. Or that any of those things were happening or were likely to happen, or that information relating to them had been or was likely to be concealed? 2.7.3. If so, did the Claimant reasonably believe that the disclosure was made in the public interest? The Claimant relies on the following as going to show the reasonable belief: - The safety of patients under the care of the Respondents was at risk The health and safety of others in the employment of the Respondents was placed at risk The disclosures included concerns relating to doctors (the Claimant’s working hours). Detriment complaints 2.8. If protected disclosures are proved, was the Claimant, on the ground of any protected disclosure found, subject to detriment by the employer or another worker in respect of any of the following:- 3 July 2019 – alleged unilateral cancellation of the Claimant’s locum sessions by Dr Mulder (without consultation or explanation) 3 July 2019 – alleged unprofessional and disrespectful conduct towards / treatment by Ms Friis when the issue of the unilateral cancellation of the locum shifts was raised by the Claimant 12 – 19 July 2019 – failure to deal promptly or at all with the Claimant’s grievance (Dr Mulder and / or Mr Laver) 2.9. The Respondents deny any of the alleged detriments. The Respondents do not rely on the statutory defence in respect of any proven detriments. Unfair dismissal complaint pursuant to section 103A of the Act 2.10. As the Claimant had two year’s service: Has the Claimant produced sufficient evidence to raise the question of whether the reason for the dismissal was any of the alleged protected disclosure(s)? Has the Respondent proved its reason for the dismissal, namely conduct. Breach of Contract 2.11. Whether the Claimant was entitled to any notice of pay in respect of the Respondents’ alleged repudiatory breaches of contract /consequential alleged constructive dismissal. Other claims pursuant to sections 44(1)(c) and/ or 100(1)(c) of the Act (health and safety detriment/ dismissal. 2.12. The Claimant relies on the matters set out above in respect of PIDA (protected disclosures). Time / limitation issues 2.12.1. The claim form was presented on 18 October 2019. Accordingly, any act of omission which took place more than three months before that date (allowing for any extension under the early conciliation provisions) is potentially out of time, so that the tribunal may not have jurisdiction. 2.12.2. Can the Claimant prove that there was conduct extending over a period which is to be treated as done at the end of the period? Is such conduct accordingly in time? 2.12.3. Was any complaint presented within such other period as the Employment Tribunal considers just and equitable? Remedies 2.13. If the Claimant succeeds, in whole or part, the Tribunal will be concerned with issues of remedy. The time allocated includes time for dealing with remedy. The claimant has indicated that compensation is / are being sought by way of remedy including (a) Injury to feelings (in respect of any established detriments) and (b) Loss of earnings. (c) Personal injury.[3]Findings of Fact References are to witness statements of the witness named or to the paper page numbers in the bundle. 3.1. The Claimant was employed as a salaried General Practitioner (“GP”) at Helios Medical Centre (“Helios”) from 1 June 2015 until her summary resignation on 19 July 2019. 3.2. The Respondent is a GP practice owned and operated by its partners. 3.3. At the material time, there were two partners. Dr Cuellar was formerly a partner. She left in May 2018. 3.4. Mr Laver is a Practice Manager. He joined Helios Medical Centre as Manager and partner in November 2014. In November 2015, he also undertook to manage Sea Mills Surgery. 3.5. Mr Laver suffered a stroke in February 2019, resulting in him being signed off as unfit to work from 8 February to 31 July. He retired from the partnership on 31 October 2019, having given notice on 1 April 2019 (166), recognising that he was not in the foreseeable future able to travel the distance to and from work and that he had been advised “it will take time” for his brain to repair. He was facing significant loss of sight and mobility. 3.6. In his absence, Ms Friis had support from Ms Kershaw, a practice manager from another surgery, and there were occasions when Mr Laver was consulted. Notwithstanding significant difficulties following his stroke, he carried out some work on a remote basis. 3.7. There had been four part-time salaried GPs. Dr Tulloh resigned in May 2019, leaving three part-time salaried GPs, Dr Feder, Dr Platford and Dr Mann as well as Dr Mulder. 3.8. On Dr Cuellar’s resignation, other GPs had been taken on but those individuals were no longer with the practice at the material times. 3.9. In addition, locums were used on sessional work. That work might be done by salaried GPs, working additional sessions on a locum basis and on locum rates. 3.10. The practice has approximately 5000 patients. There was a Care Quality Commission (“CQC”) report published in August 2015, based on an inspection in July 2015, which was good, showing a safe, effective and caring service to 3.11. Ms Friis started work at Helios Medical Centre in March 2019 as operations manager. She had fulfilled that role at Sea Mills, working under Mr Laver. There had previously been an Operations Manager in post until December 2018. Ms Friis is not a trained practice manager. 3.12. The practice had detailed grievance, disciplinary, health and safety and whistleblowing policies. Mr Laver was the person with whom whistleblowing concerns were to be raised under the whistleblowing policy in place at the time (page 4 of policy). 3.13. Dr Mann’s contract entitled her to an annual fee of £8250 per session per week, and the contract hours were 3 sessions, Wednesday morning and Friday all day, calculated as 13 hours in total (128). GPs were expected to complete their work after hours, if necessary for the proper performance of their duties. Overtime could be authorised by the manager, but that provision was not applied during the period in question (128). 3.14. There is a limited and informal internal approach to appraisal. There is the usual annual NHS independent clinical appraisal, which here took place in April 2019. 3.15. Salaried GPs work for booked clinical sessions typically with 13 slots of 15 mins duration and one 15 minute break, totalling 3.5 hours) (Mulder para 15). Additional time is allowed if a GP is supervising a trainee GP. 3.16. There is also a system for triage sessions. Dr Mulder explains that during any given triage session, the duty GP has a list of call-backs which are telephone calls to patients in addition to attending to patients in person in the clinic (Mulder, para 18). 3.17. Paperwork includes checking and signing prescriptions, reviewing lab results and dealing with incoming correspondence. 3.18. Dr Mulder describes the arrangements at paragraph 23 of his witness statement– “If on any given day, when 2 doctors are on shift, one is assigned to cover triage as a duty GP to deal with urgent matters that cannot wait until a bookable appointment becomes available. The other Doctor is assigned to attend pre-booked appointments. 3.19. He goes on to explain that in the event that there is only one doctor on shift, there are options:a. Locum GPs are called at short notice to cover shiftsb. Non-urgent patients are diverted to a later day, or to alternative services such as pharmacistsc. Urgent patients are diverted to A and E (para 21). “Consequently no patient or staff are ever placed at risk due to staff shortages.” (para 23) 3.20. Ms Friis says that when she started, she found the staff team to be weak because two nurses had left, and she says the Practice was short staffed with salaried GPs. The Reception staff were stressed and felt unsupported (Friis para 3). 3.21. No difficulties are reported by Dr Mann herself or by Dr Mulder with Dr Mann prior to 2019. 3.22. Dr Mann had no difficulty with staff relationships until 2019. She was wellregarded and seen as an asset to the practice, as Mr Laver and Dr Cuellar also confirm. She had earlier been offered a partnership but declined. Dr Muldar had found Dr Mann to be pleasant in his dealings with her, and she was co-operative and helpful over arrangements during his holiday absence in 2018 (159, 160) with messages indicating a sound working relationship. 3.23. She describes the difficulties arising in 2019 at paragraph 8 of her witness statement: - “Working life began to get more challenging from January 2019. It became dysfunctional in the practice without an operations manager. Triage clinics were getting busier due to lack of staff, emails were coming in from patients and not being monitored with no policy in place on how they should be processed, 5 minute follow-up telephone calls were being used for new medical complaints, there was a lack of proper procedure with prescribing and lack of adequate paperwork cover when a GP was away. There was discontent in the staff and I heard numerous complaints about stress levels rising. I had also begun to feel stressed. March 2019 3.24. Dr Mann in her witness statement at paragraph 10 describes concerns about prescribing. “Around March/Early April, I felt things may start to improve as I felt support was coming in, for example we had a meeting to organise a prescribing policy, something which had not been addressed and needed attention after concerns were raised where a receptionist had started medications for patients without GP input, including controlled drugs where an opioid drug patch was issued to a patient with Parkinson’s disease who had never had it before, with no indication or authorisation by a Doctor.” 3.25. In early March 2019, there was an Incident over a prescription for escitalopram. 3.26. Dr Mann has this recollection. “It was in relation to a lady that I knew, who had seen me in a booked clinic and she is a lady who lives predominantly abroad. She had consent to collect prescriptions for herself and her husband. She had asked me to issue a higher dose for escitalopram for her husband. I had previously said I would like to see him next time, and on this occasion, she had asked again, for the dose to be increased. He was already on 10 mg of escitalopram, the highest usual dose. So I said I need to see him to assess whether he should be on a higher dose. Please ask him to book with me and then I can look into it. So yes, I declined, for her husband. I was not refusing her own medication. The consent on the form was only for the issue of routine medication. Mohima presented a pile of paper prescriptions, and in there was a 20 mg of escitalopram for this patient’s husband and it was based on his past medication list, not current, and I had already had a discussion with his wife, that I was declining issuing it, so I did not know why I was being presented with it to be signed. I asked “what is this about” and Mohima said she said she really needed it, and so we wrote it up as a significant event” (oral evidence). 3.27. Mohima was a receptionist. 3.28. This was a matter for Dr Mann’s clinical judgment. The explanation Dr Mann gives indicates that Mohima was acting in excess of her authority in attempting to obtain a dose of escitalopram at a higher level, even if she was unaware of Dr Mann’s earlier refusal or the reasons for it. 3.29. On 8 March 2019, Mohima sent an email to the clinicians (162.1). She asked that GPs check prescriptions before signing them and that GPs approve methadone prescriptions. She explained “As far as I was trained we were allowed to req past drugs, actue (sic) and restard (sic) them, however, now I am being told I can only req current repeat drugs and repeat dispensing only, which I am now only doing.” 3.30. She said she was not comfortable issuing any controlled drug or methadone scripts although that had been something she had been doing after an earlier receptionist left. Those would now be referred to the GPs. 3.31. The issue of that email by Mohima led to her being invited to a disciplinary hearing by Ms Kershaw (163). Possible consequences included a verbal or written warning. 3.32. There had just been a policy meeting which had considered the use of the triage system. One of the issues was medication being put to the triage doctor to issue, inappropriately. 3.33. On 20 March 2019, a patient was put on the triage call-back list because she wanted her request for a repeat prescription for a controlled drug to be prioritised, having run out shortly after she made the request. Dr Mann was on triage and was asked to deal with it. The notes indicated to her that the patient was not due a repeat prescription for a couple of weeks and on clinical grounds, Dr Mann declined to issue the repeat prescription. In her judgment, the patient needed to speak to a doctor who knew her case the next day and she was put on Dr Mulder’s list. 3.34. Dr Mann explains, “The patient was put on my triage list to call back because she was demanding that this medication as issued. As part of the policy to curb inappropriate calls demanding prescriptions, I was feeding back to reception the reasons for not prescribing and offering an alternative that she could follow up with her usual GP who knew her case” (oral evidence) 3.35. The receptionist she spoke to was Mohima. Dr Mann’s account is that Mohima put the phone down on her, and Dr Mann came out of her room to remonstrate with her. 3.36. Mohima had a disciplinary hearing, also on 20 March, after earlier difficulties and errors in relation to prescribing (163.3). She was given a warning about the seriousness of such mistakes and that she could not afford a repetition. She was invited to a further disciplinary hearing on 21 March regarding the “prescribing issue and dictation to GP”, which is a reference to the incident on 20 March above. Dr Mann provided a statement. Mohima resigned the following day, 22 March, giving a month’s notice. 3.37. Dr Mann refused to work with Mohima after 28 March. That was, she explains because, “The following week at a clinical meeting, it was casually disclosed that Mohima had said to another receptionist that she thought I was going to hit her. I had come out of my room in exasperation when she put the phone down, and I was trying to explain the policy to her….there was a table between us, quite raised. And so this allegation was unfounded. We discussed it at the practice meeting and it was agreed how could that be possible and afterwards I reflected on it and I felt that was a serious accusation and I therefore asked that witness statements were written up by those who witnessed it” (oral evidence. 3.38. From Dr Mann’s perspective, there had been a recent discussion with Mohima about prescriptions. This was a further instance of challenging conduct and a concerning allegation about the threat of violence, agreed by Ms Friis to be fabricated. 3.39. Dr Mann sent a text message to Dr Mulder on 28 March, “I have spoken to Dagma (Ms Friis) today about Mohima’s comment about me. Although it was disclosed to me in a casual manner, I am taking this very seriously. I have asked that both Dagma and Holly write a report of what happened as they were present and I have said that I will not work with Mohima from now on. At the clinical meeting yesterday we discussed reasons why Mohima would say such a thing without cause. In my mind that is not enough and needs further action. To continue working with her, I feel, leaves me vulnerable to further unfounded accusations and in our line of work honesty and trust is of utmost importance.” (156) 3.40. Dr Mulder responded promptly, “Agree. She was leaving anyway. Think it is in hand now” (290). 3.41. Ms Friis provided a statement for the investigation because of the allegation made that Dr Mann might hit Mohima. This is the full statement. “I was aware of situation going on with difficult patient on phone to Mohima. Dr Sonia Mann came out of her room stood outside my door and asked Mohima “did you put the phone down on me.” Mo said she did not. Sonia said “yes you did, don’t ever do that again.” At no time did Dr Mann go behind or near Mohima as the desk was between them and the door closed (they were communicating over the desk) I spoke to Dr Mann who was quite distressed as Mohima has been constantly rude. This was not the first time I had heard about Mohima’s behaviour, being disrespectful to the doctors” (231). 3.42. The statement says nothing about Dr Mann being aggressive or shouting. 3.43. Mohima was informed on 28 March that she was not required to work her notice (163). 3.44. Ms Kershaw wrote that day to Dr Mann, copying in Dr Mulder, Mr Laver and Ms Friis: - “Sonia We have agreed today that Mohima was not required to work her notice period and could leave today….. I have been provided today with (illegible) witness statements confirming your recollection of events and would like to have a quick catch up next week to ensure that you are happy with today’s mitigation or whether you would like more assurances.” (164) 3.45. That is confirmation that Mohima’s allegation that she thought Dr Mann was going to hit her was dismissed. April 2019 3.46. On 24 April, Ms Friis raised with Dr Mann that she was being underused. Ms Friis had carried out an investigation using EMIS looking at 5 April and in her interpretation, Dr Mann was not using 50% of appointment time. Ms Friis had raised this on her own initiative and had not discussed it with any clinician. 3.47. Dr Mann was unhappy at this challenge to her professional practice. “I was shocked and confused, I asked her to explain as I had fully booked clinics and we all were aware that a lack of booked appointments was an ongoing concern. I asked her to show me what she meant and she then referred to triage clinics. This did not make sense to me as I was working in line with all GPs in the triage of patients. I said I felt uncomfortable and that this should be discussed with all doctors present, in an open meeting.” (Mann, para 17) 3.48. Dr Mann raised this with Dr Mulder, and they arranged a meeting the next day (156). He also conducted an informal appraisal that day, describing her, as he himself puts it, as “the good news”. He expressed no concerns about her performance. 3.49. Dr Mann also found that on 25 April, Ms Friis had booked a routine medication review into her triage clinic as a result of which she ran late, and that the same was happening in later triage clinics for which she was duty GP (Mann para 18). 3.50. On 29 April, Dr Mann requested a pay review, her pay having been static since June 2015 (167.1) May 2019 3.51. Dr Mann raised both matters – the use of triage for routine appointments and the suggestion that her time was not well used – at a meeting on 1 April a meeting at which she is described with hindsight as eloquent but angry (220.1). This is from the minute of the meeting, “Sonia wanted to discuss the triage system as she had some routine appointments booked into her slots both last week and this week. Sonia mentioned a discussion with Ms Friis last week that made her feel uncomfortable and that she now feels singled out as the appointment complication had only happened to her. Ms Friis explained why she had a discussion with Sonia last week….. we need to ensure everyone is working to capacity…. This should be discussed with the clinical team as a whole however. Sonia should not be singled out, as all GPs are working in line with Triage protocol as it stands. It was agreed between the group that the short staff issue was a big pressure and we hope to appoint into the vacancies will reduce this. Agreed between us that triage is solely for triage and not routine UNLESS discussed with the GP beforehand. Triage is already hard work and often complicated without the added pressure.” (167.9) 3.52. On 13 May, an increase in Dr Mann’s salary was offered bringing it to £8500 per annum per session, totally an addition £750 per year. It was not accepted or paid. 3.53. Dr Mann had been carrying out additional sessions on Tuesday mornings that Dr Cuellar had done until 2018. She had accepted them on the basis that she would see how it went. She did them as a salaried GP, rather than as a locum but her written contract did not refer to them. 3.54. On 13 May, she cancelled her Tuesday sessions with effect from 1 June 2019, giving two weeks’ notice, “I will no longer be able to offer regular Tuesday am sessions or partake in the CCG forum from 1/06/19. I can offer to do locum sessions from time to time, either on a Tuesday or Thursday.” (167.6) 3.55. She does not explain why she gave short notice. She does explain that she wanted greater flexibility over her work. 3.56. There was a shortage of locum cover in June. Additional locum cover for every Monday, Tuesday and Thursday in June from the salaried team had been requested in May (167.5). 3.57. On 21 May, Ms Friis booked Dr Mann in to work on three Tuesdays in June as a locum together with three Thursdays (168). They are all full days of triage because she had nobody else available at that time. She offers to “switch these triage calls to half day” if she could get someone else. 3.58. There was no untoward incident on 21 May. 3.59. There was a meeting between Ms Kershaw and Dr Mann on the following day, the details of which Ms Kershaw confirmed to Dr Mann that evening, copying in the two partners, given that she was only offering management support and lacked the authority to make decisions. 3.60. Ms Kershaw and Dr Mann had discussed Ms Friis’s conduct and it was accepted by Ms Kershaw that, “…she attempts improvements with gusto but her delivery can sometimes be a little insensitive. I do believe that with some nurturing this can be improved but equally she has arrived with great expectation and in difficult circumstances so her stress levels may dilute her good intent. I trust after she has reflected and you both get the chance to discuss, a line can be drawn.” (171) 3.61. Ms Kershaw included guidance on salary and locum fees, “I completely agree that with the absence of a full complement of salaried GPs and a reliance on locums the admin workload increases for the loyal salaried GPs and this should be considered…” And, “I concur that if your locum sessions include triage especially when Frank is away that this should be reflected in your invoice but I cannot authorise.” 3.62. She thought that there should be clarity about the role of the triage GP, “The pressure of locums is apparent across the estate and I feel the reception team deviate from this system to try to alleviate patient discontent …” 3.63. It ends, “I know I speak on behalf of Rich and Frank when I say you are a valuable asset to the Helios team and it would be a devastating blow to the practice to lose you.” 3.64. Following that discussion, and in reply to Ms Friis’ proposals in respect of locum sessions on 21 May, Dr Mann asked for some adjustments to her Friday clinics, to accommodate what she described as these “high frequency duty sessions” but agreed to do them. 3.65. In the same email, she wrote saying that she had spoken to Jenny Kershaw about the triage clinics and charges and what is paid to experienced GPs working triage, “To confirm, I will be charging Triage clinics at an hourly rate of £80 per hour with an extra £100 per session worked.”(168) 3.66. Ms Friis responded promptly agreeing the fees she proposed (170). It was within her authority to do so, as Mr Laver agreed (oral evidence). 3.67. Ms Friis emailed Dr Mulder and Mr Laver the details of Dr Mann’s charges on 31 May (Laver para 27). They had not been copied in when she agreed them. June 2019 3.68. On 7 June, a problem arose over the attendance at the surgery of a patient of Dr Mulder. He wanted a methadone script. Dr Mulder was the prescribing doctor for his methadone and had not left a signed script. Dr Platford was duty GP in the morning. She had a difficult morning. Dr Mann was duty GP in the afternoon. The patient arrived at about 1.15 pm as Dr Platford was leaving for lunch. 3.69. Dr Mann’s account is that, “I looked at (the patient’s) notes and saw there was no clear plan or note for what dose he should be on. A few weeks prior Dr Feder had written that (the patient) keeps asking for inappropriate medications and a clear plan should be made for him. He had an appointment at a later date with Frank, however, there was nothing documented in that consultation to clarify his prescribing plan. I asked if Frank could be contacted to clarify this. I then said I would review again after lunch and did the script on my return as I then had the necessary information.” (Mann para 27) 3.70. The patient was therefore kept waiting. 3.71. Dr Mann’s clinical notes show, “Pt walk in seeking prescription for methadone script. Weekly script not done. Under c/o Dr Mulder re methadone scripts. Review of regime and Abbie has spoken to Dr Mulder and he advised script can be issued today.” 3.72. She signed the script that afternoon. 3.73. Later that day, the senior receptionist challenged Dr Mann. In her account, Dr Mann says, “A short while later, Holly came to see me and was visibly angry, she said Joan had just walked out when told (the patient) was here. She asked why receptionists were left alone. I explained what I had advised Abbie and that there was no reason for a Doctor to be present, plus with 2 receptionists together, Abbie was not alone.” (Mann para 28) 3.74. Holly with Abbie, the receptionist who had been on duty over the lunch hour, then challenged Dr Platford. 3.75. Dr Mann goes on, “I was present when Holly accused Joan of leaving reception and not dealing with the issue. Joan was very upset by this, saying it was not her duty to deal with reception in this way and she had had enough of working like this, took her bag and walked out mid-clinic.” 3.76. Dr Platford was angry and upset, and exhausted. She walked out in the middle of her clinic and did not return that day. 3.77. Dr Platford emailed the two partners and Ms Friis that evening to say she was seeking a GP to obtain a med 3 with the diagnosis of stress and chest pain, under investigation, giving a brief account of the confrontation and reiterating that she had never in all her career walked out of work. “I had to leave work early today after an incident and confrontation by Holly which left me utterly incapable of seeing my remaining patients as I was so upset and angry.” (181.4) 3.78. Dr Platford added a lengthy note the next day (181.2). She had gone for lunch after a difficult morning which included getting a child admitted as an emergency. She had started work at 7.30 am. She finished for lunch at 1.20, not having had a break. “I was totally exhausted, feeling faint, and needed to have lunch to get back in time for my afternoon telephone calls so I went home for lunch….. Both of them came into my room… and Holly accused me of upsetting Abbie and said Abbie was going to leave because of this. Abbie was accusing me of “running off”. Well yes in a way but because I was no longer duty doctor and simply had no strength left and had a fully booked afternoon surgery. 3.79. Richard Laver commented paragraph by paragraph in his reply, “You did nothing wrong, Joan, and nor did Sonia if she signed the script. I have issues with you then being confronted….where is the respect?” 3.80. Dr Platford’s email continues, “For me this was the last straw and I was also enraged and deeply upset about the insensitive way Holly dealt with it, because I just simply was unable to see any more patients (I was already feeling pretty burnt out by the heavy morning with some very complex issues to deal with). … I now realise I have no resilience left and feel unsupported and undervalued.” 3.81. The email opened with the following, “The incident has to be seen on a background of extreme pressure at work and a pervasive feeling from both Sonia and I that important issues are not discussed: for example we were supposed to discuss the whole triage system as an urgent matter…. We just never talk about important issues.” (181.2) 3.82. Dr Platford was admitted to hospital with sepsis on Tuesday, 11 June. She had two weeks sick leave (221). 3.83. Dr Mulder was due to go on annual leave for three weeks in the second week of June. Dr Tulloh had left the previous month. Dr Mann and Dr Platford usually covered for each other. Dr Mulder and Dr Cuellar had had a similar arrangement. 3.84. Mr Laver accepts that at this time, “There was a shortage of staff due to attrition and/or annual leave and gaps were covered by locum GPs including Dr Mann.” (Laver, para 31) 3.85. On 5 June, Dr Mann had sent an email to Dr Mulder, Dr Platford and Professor Feder and two administrators including Ms Friis, asking “Please can we sort out cover for holidays, for example who is to cover Frank from next week. Joan said she did not have enough time to cover my docman whilst I was away. Do we need to factor in admin sessions?”. (para 25 and 180) 3.86. Ms Friis replied to her alone, asking who should be doing it and how long should be factored in for it. 3.87. In response, Dr Mann wrote, on 7 June, “We should discuss this as a team, asap” , and also suggested that they adopt a practice policy on emails coming in from patients (179). 3.88. Ms Friis reported that Dr Mulder had suggested an hour per week to cover his absence, for the GP who was going to do this, but again writing only to Dr Mann. Dr Mann replied that one hour per week was not enough, copying in her clinical colleagues. Ms Friis retracted, saying she had misunderstood Dr Mulder, and it should be one hour per day, “but obviously if you need more please let me know.” Again, she only replied to Dr Mann. 3.89. It was not Dr Mann’s responsibility to arrange cover for Dr Mulder’s paperwork. 3.90. Dr Mann replied in firm terms on 11 June, again copying in her clinical colleagues, “I am unable to come in early to do paperwork as suggested in previous email. ….I think the paperwork needs to be shared amongst all staff. I covered Joan’s paperwork when she was away and now I am expected to cover Franks? I am triage as Locum today and have had no time to do any paperwork, it is now 1 pm. I must say I am unhappy with the way this is being dealt with last minute. … This is patient safety issue for obvious reasons. Please can management sort this out. Perhaps some other Drs have some suggestions and be cc’d into correspondence on this subject in the future.” (174) 3.91. Ms Friis replied, again to Dr Mann only, “Please be aware that we really want to support you. Yesterday we had Dr Nimenko do Joan’s and most of your scripts and results. It is very difficult when a doctor is off sick to organise everything, especially in view of the fact we do not have a practice manager at the moment. Richard will be back at the end of July so things will get better. We are interviewing doctors to join the practice. Please only do what you can. Anything you can forward to reception me or secretary please do.” (178) 3.92. Ms Friis was going to ask the locums to help out so that Dr Mann was not inundated, and she had put on extra GP sessions 3.93. The tone is supportive. The question is whether the support was there in practice. 3.94. There was no other reply to that email. 3.95. There were other signs of pressure on the practice. Professor Feder commented in relation to a technical problem with phone calls on 7 June, “Triage is pressurised enough as it is… not being able to ring patients is a camel’s (GP’s) back-breaking straw (181) 3.96. In Dr Mulder’s evidence, he says that he had arranged for Ms Friis to have Sonia cover his paperwork for one hour per day, which perhaps explains why Ms Friis directed her replies at Dr Mann only (Mulder para 60). There is no other message or email or note dealing with this. Dr Mulder did not speak to Dr Mann about it. 3.97. Dr Mulder left on holiday on 11 June having stayed to do Dr Platford’s clinic. 3.98. Dr Mann learned of Joan’s illness and absence on Tuesday 11 June and sent a text message to Dr Mulder, “Hi Frank, I understand Joan is off sick with stress this week. I have sent an email regarding paperwork cover. I explained to Ms Friis I’m not accepting responsibility of covering all paperwork for yourself and Joan as I can just about keep up with my own. Sonia.” (157) His reply, “Sure. About the one hour a week for paperwork that was a misunderstanding between me and Ms Friis which I hope has been resolved. Joan will hopefully be back next week and we are working on getting more cover. All you can do is your best within reason and take a bite off the stack as best you can in the time available. Thank you for chipping in. Frank.” (157) 3.99. Her reply, “Maybe I’m not making myself clear. It’s not only about work load but more importantly about patient safety. I take it that you’ll be remotely accessing results so nothing important slips the net.” (157) 3.100. There was no reply to that. There was no reply to Dr Mann’s earlier enquiry about arrangements for cover for Dr Mulder, other than Ms Friis’s replies above. 12 June 2019 3.101. On 12 June, Dr Mann was the only qualified GP present. Dr Mann had a fully booked clinic. There was no triage GP. 3.102. Dr Mann was responsible for supervising a foundation doctor. Normally time would be provided for that. Because there was no adequate supervision for the trainee, she stopped attending the Helios that week (Mann para 43). 3.103. Dr Mann says, in her witness statement, in relation to the absence of a triage GP, “I was dumbfounded. I did not think it was possible that this would be allowed to occur, especially after concerns raised about busy triage clinics and the role of routine clinics and triage clinics. … I asked why there was no triage GP with a fully booked routine clinic. Chloe said she did not know but had been telling patients who called for an urgent appointment to call 111 instead. These patients were then being told to contact their GP as it is the duty of the GP in hours to provide this service. Emails from 111 then came back to the practice that day with patient contact requests.” (Mann, para 36, 37) 3.104. Dr Mann asked to have her booked clinic patients cancelled so that she could assume the responsibility of triage. Holly King refused to cancel the patients. Ms Friis was not there. 3.105. Dr Mann says she felt, “abandoned, unsupported and extremely anxious and overwhelmed. I felt as if I were in freefall without a parachute.” 3.106. She spoke to Richard Laver, who undertook to try to get cover for the future, and agreed she should act as the triage GP for that day and for Friday if cover could not be found, (Mann, para 45) “He assured me that they would be seeking cover because later in the week, I had a fully booked clinic, but they had no triage doctor, and we agreed that if cover could not be found, I could cancel that clinic so I could assume the responsibility of triage.” (Oral evidence 15/22) 3.107. She wrote to the two partners, coping in the two other doctors and Ms Friis, “Today I arrived at work to find no triage Dr booked and I have a booked clinic. I asked Holly to cancel my booked clinic to which she replied “no” and then walked out of the practice. I have seen there is no cover doctor booked for Friday. I understand Frank left for Greece yesterday, despite the practice left the way it is. Joan is off sick this week. This situation is unacceptable and unsafe. I have spoken to both Richard and Dagma today. Dagma states she has tried to get locums but failed, however there has been no adverts on BASD (Bristol Association of Sessional Doctors) and no one has yet contacted Gene or Louise who apparently have said they could cover a Thursday or Friday. There is no clear plan who is responsible for paperwork/labs etc. I’ve been told “just do what you can”. This again is a patient safety concern. I am the only doctor here left to deal with the whole patient population with no clear idea about locum cover and work load cover. I feel it is unsafe to continue to practice under these circumstances as it poses a high risk of potential harm to patients. I understand Dagma is trying to get hold of Frank (I have texted him) and will contact Richard so the CQC can be informed.” (184) 3.108. Mr Laver responded promptly to her email (184). He had been in touch on that Monday with the practice knowing Joan was ill and had been told they needed cover for Tuesday and Friday afternoons and that Frank had covered Tuesday afternoon because no locum had been found. He was advertising for help for Friday. Mr Laver copied his email to the usual team, Dr Mulder, Professor Feder, and the administration. 3.109. He does not mention any report of Wednesday 12 June being without a triage GP. 3.110. Noting that Holly had refused to cancel the clinic and walked out, Mr Laver says, “Given that Joan walked out on Friday following a confrontation with Holly and you have had an issue this morning, who on site is going to talk to Holly?” 3.111. In relation to her proposal that the CQC should be informed, Mr Laver said, “I do not wish to notify the CQC at this stage. We would need to notify the CQC if we are unable to provide a service. Let’s see what solutions can be found.” 3.112. Dr Mann also sent a text to Frank Mulder on 12 June, at 10.50 am, “Situation in crisis, no duty dr booked this morning. I am left alone the whole week. No-one seems to be sorting this out. I think you need to be here, Frank. Sonia.” (157) 3.113. There was no reply to that. 3.114. Profession Feder replied to Mr Laver’s email, agreeing to cover the triage session and “mopping up results, Rx and docman” from 11 am onwards on Friday 14 June, but hoping not to do the whole afternoon (185). 3.115. On 12 June, Dr Mann raised a grievance, “I request a formal grievance meeting to discuss: Lack of support by the Partnership in my role as a Salaried GP Unsafe working within the practice which has been highlighted on several occasions with ineffectual resolution ie lack of adequate action about concerns raised. Risk to patient safety Poor communication amongst staff members No response to last email regarding pay appraisal. (182) 3.116. She had a detailed response from Richard Laver but he acknowledged he would have to leave the grievance to Frank to address on his return (183). 3.117. On 13 June, at 18.29 pm, Dr Mann emailed a further complaint, “I am being placed under unreasonable stress and expected to shoulder responsibility as if I was a Partner…. Still no cover tomorrow from Duty GP from 9 am until 11.20 am when Gene has been booked to arrive. I have a fully booked clinic from 9 am This situation is causing me considerable stress, I have had migraines all week and I cannot be expected to work under these conditions” (186). 3.118. Dr Mann was off sick on 14 June until 19 June. She explains in her witness statement, “The next morning, I was overwhelmed with anxiety, headaches and nausea. I felt I could not work safely. Despite all my attempts to resolve the situation and communicate that I could not be expected to work as duty GP/triage and do a booked clinic, I had no adequate resolution.” (Mann, para 54). 3.119. On 17 June, she provided a fit note citing stress at work, for the period 14 to 19 June (188). 3.120. On 18 June, she replied at some length to Richard Laver, commenting on his comments on her grievance and giving some of the background going back to April and Ms Friis’s conduct then (188.2) She makes her concerns more explicit, for example, “I am entitled to a working environment in which I feel safe to practice. Last week led to a tipping point. No one communicated with me that Joan was off sick for the week. I only found out by chance as I was leaving the practice on Tuesday. The next day I arrive at work with a fully booked clinic and no triage doctor and receptionist refusing to cancel my booked appointments. I was told Frank had left for holiday on Tuesday evening despite knowing there was inadequate cover organised for the coming week. I texted Frank and I had no response from him. I felt I was left shouldering the responsibility of the practice and felt totally unsupported. Why was I expected to deal with emergencies and a booked clinic along with Joan’s paperwork and Frank’s? Why was it assumed that I could do with work of 2 doctors?” (188.2) 3.121. On 18 June, Ms Friis emailed Dr Mann, copying in Dr Mulder, Mr Laver and Ms Kershaw about Dr Mann’s return to work on 19 June. They had had 3 doctors absent, Dr Mulder, Dr Mann and Dr Platford. While she said, “I hope you are feeling better. I have implemented as much support over the next few days as I have been able.” (188) she had not been able to fill the Friday morning triage on 20 June 2019, when Dr Mann had been booked for patient facing appointments, 3.122. Ms Friis also said, I have had a locum session just doing yours, Joan’s and Frank’s admin so you won’t be overloaded.” (188.3) 3.123. Dr Mann reports that on her return to work the following day, her paperwork had not been covered while she was away: “On the actual day that I arrived back to work, I was told that the paperwork had not been looked at and the EPSs (Electronic prescribing scripts) had not been done because the locums did not have the training, so the reality is that it was not as set out” (oral evidence). 3.124. On 20 June, Dr Mann worked the full day as triage GP. The following day, she had a fully booked clinic but no triage GP had been booked. 3.125. There was a meeting between Dr Mann and Ms Friis on 20 June. Dr Mann was angry at having no GP on triage for the following day, while she was dealing with patients face to face. The expectation was that she would also deal with urgent calls, as Ms Friis confirms in her note of the discussion (188.5). Dr Mann found that unacceptable. Dr Mann commented, She came in and apologised no cover for paperwork over recent days, locums not able to do EPS or docman, and I remember that she suggested that for the next day, I would have a booked clinic and she would tell people there was no appointment and they would have to call back on Monday, but if really urgent, defer to afternoon. I could not quite believe my ears, I had raised several emails saying this scenario would be unacceptable because unsafe for patients. Unsafe for patients. If you are deferring urgent calls. Putting routine appointments precedence over urgent care. A patient could come to harm” (oral evidence page 16, Mann para 57) 3.126. Ms Friis sent Dr Mann an email at 13.45 that day, Dear Sonia, I have had formal notice from Frank This is to let you know that you are not responsible for other people’s inboxes. If you have the time to look at the global view in EMIS that is appreciated, but a plan is in place for them to be auctioned (actioned) today and tomorrow. VBW Dagma” (188.4) 3.127. On 21 June, Dr Mann sent a text message to Richard Laver, “Dear Richard, Ms Friis yesterday proposed to me that there should be no triage GP and I could still have my booked clinic. She said “other practices do this” and that she will man the front desk and tell patients there is no doctor and to call back on Monday. She said this was discussed with you Richard. This is despite my emails and conversations about how unsafe I felt this scenario would be and a condition for my return to work. Why would she even propose this? She eventually changed my clinic to a triage and cancelled my booked surgery after I said it was unacceptable. I feel there is no real support or trust here. I will not be working today due to the stress of this so please let the practice know. I will discuss this with my own GP and provide a further note on Monday. Sonia” (248) 3.128. The reply was, “Sonia, Ms Friis emailed me to say that she was proposing this and I asked her to speak to you about it. I will let the Practice know that you are not coming in. Can I also respectfully point out that I am on sick leave following a stroke and am unable to come in/work at present. This is not something I can do much about. I appreciate this is not ideal for anyone.” (249) 3.129. Dr Mann replies “Please let me know who is in charge of running the practice.” (250) 3.130. The reply is “Ms Friis is the person on site and in charge at present.” 3.131. Dr Mann was off sick that day and a fit note was provided to cover her absence for 21 to 22 June citing “stress at work”(189). 3.132. On Monday 24 June, one of her non-working days, Dr Mann emailed Ms Friis, copying in the partners, “ Please can you communicate to me what doctors are present this week and for which days/sessions”. (198) 3.133. In a further email, of the same date, confirming her return to work, “I understand Dr Platford is back this week – please confirm this. I will not be expected to do booked clinic and triage in the same session.” (198) 3.134. On 28 June, Dr Mann emailed Dr Mulder asking for her grievance meeting as soon as possible (191). She also asked for a meeting to discuss her pay appraisal. 3.135. She also emailed Ms Friis to point out that for the next fortnight she had only triage clinics, which meant that there were no routine appointments for patients which made it difficult to establish continuity of care. She also complained again that triage is blocked with inappropriate calls and prescription requests. She asked for some routine clinics to be included. Holly King Complaint June 2016 3.136. On 30 June, Holly King wrote to Ms Friis, “In light of recent events, I wanted to tell you about my concerns regarding working with Dr Mann.” (191.3) 3.137. She makes allegations as to how difficult it was to work with Dr Mann, “Since I started at Helios in March 2018, I have found it increasingly more difficult working with Dr Mann. She is extremely difficult to approach, she seems to dislike working as part of a team, and is very abrupt in her manner, we have also been told this, by many patients, who refuse to be seen by her.” 3.138. She then writes about an incident “sometime in May”. The incident described the one that took place in March, involving Mohima. She alleged that she had been under pressure to change her statement about that incident, from Dr Mann because in her statement at the time, she had said that Dr Mann had shouted at the employee. “Dr Mann insisted I change her statement to say she didn’t shout.” 3.139. Two statements have been produced. Both are headed “May”. Dr Mann says that the full and damaging statement was never shown to her. She saw a different one. 3.140. It is worth referring back to Ms Kershaw’s email of 28 June, when the statements taken on investigation confirmed Dr Mann’s account of this incident and to Ms Friis’ own account at the time, which contained no allegation of shouting or aggressive behaviour by Dr Mann (164 and 231). 3.141. Ms King goes on in her email of 30 June to write about the incident on 7 June when a patient, calling in over lunchtime for methadone waited in reception until Dr Mann came back from lunch in the afternoon. Dr Platford had been challenged by Ms King over this, but in this statement, Ms King places the responsibility on Dr Mann without mentioning Dr Platford, “On Friday 7 June, she left a young female receptionist alone with a methadone dependent patient for 1/5 hours while she went to lunch, refusing to do his blue script, and told the receptionist to call Dr Mulder at his home. The receptionist felt that she was left in potential danger.” 3.142. She goes on, “The following Wednesday Dr Mann refused to work her whole days clinic because there was no triage GP that day. She insisted I call every patient to cancel their appointments. I refused, as I considered this to be an extremely unreasonable request. She was aggressive and intimidating.” (191.3) 3.143. She then says she has been off sick since then with stress as a direct result of Dr Mann’s treatment of her and her team. 3.144. There is no other document making an allegation that Dr Mann was aggressive or intimidating. 3.145. Neither Ms Friis nor Dr Mulder remember getting this email. There was no investigation. It was not recognised as a formal grievance “in respect of her aggressive and abusive conduct towards Ms King personally and the Reception Team in general” or dealt with as such (see Response para 66). July 3.146. On 1 June, Dr Mann submitted an invoice for five days of locum sessions, at the rate agreed with Ms Friis, and including a £50 penalty payment to be levied if payment was not made promptly. She had not charged a penalty rate before but, found that delays in payment became time wasting and troublesome so included it on this occasion. Other locums had mentioned making similar provision. She did not actually charge it. There had been no prior discussion about it with the practice, “It was a new thing I added as an addition to ensure I would get a timely payment because on previous occasions, one spends quite a bit of time chasing invoice payments. It was a new addition. I know that I did not put that in a previous invoice to Mr Laver.” (oral evidence) 3.147. She charged per hour, not per session or sessional hour. 3.148. Another locum GP also submitted an invoice for days at the end of June charging per hour for triage/surgery/admin (191). 3.149. On Tuesday 2 June, Ms Friis wrote, “Hi Sonia I have cancelled your 9th and 16th sessions for locum cover Kind regards Dagma” (196) 3.150. Ms Friis told the Tribunal that this was her decision. Holly King Back to Work Meeting 3.151. On 3 June, Ms King had a Back to Work meeting with Ms Friis (197.3). 3.152. She had been off work with stress. She is asked about that, “What caused you to be stressed?” “I have been stressed for months due to lack of support in management. Sickness with members of staff. Dealing with Kate’s work as well as my own work. I was also not supported by my job share.” 3.153. She does not mention Dr Mann. She does not repeat her allegation of 30 June that Dr Mann caused her to be off work sick. There is no reference to or discussion of the email of 30 June. 3.154. She does refer to the incident of 7 June, “On Friday 7 June, I arrived at 4pm to work and close Helios. I found Abbie stressed out, she told me that the blue script person had been in at lunch time, everybody knew him to be volatile and aggressive. Sonia and Joan knew he was out here and Joan went to lunch, Sonia came out saw him and said “I am not dealing with that I am going to lunch. Abbie said what shall I do? Sonia said call Frank. She was left with a patient and no GP on site. He harassed other nursing staff and reception staff until both doctors returned from lunch.” 3.155. The complaint continues and is more about Dr Platford than about Dr Mann. Holly King here is not saying that the receptionist was left alone. 3.156. There is a reference to 12 June, when they “realised we had no-one to do triage.” Ms King is noted as saying, “Chloe and myself decided we would put no calls through to Sonia. Patient called for a script so I messaged Sonia please do script, I couldn’t find locum. Sonia said not good enough have a full clinic, you have to cancel clinic. I said are you serious? I spent all day rescheduling for Joan’s clinic now your telling me you want me to cancel your clinic. You are not working as part of a team. I am not doing it and you cancel the patients yourself…..Why do you want to make it difficult. I’m fed up with you being horrid to us” 3.157. She confirms that she walked out. 3.158. No reproof for her tone is noted in Ms Friis’ notes. 3.159. Ms Friis asked her what changes she wanted. The list given includes support from GPs for reception, extra staff for holidays or sickness, greater authority in handling reception staff. There is no mention of the concerns reported in the email of 30 June. It is not suggested that Dr Mann was aggressive or abusive. 3 July 2019 Meeting 3.160. There was a meeting between Ms Friis and Dr Mann on Wednesday 3 July, of which Dr Mann writes, “I suspected something sinister was happening, as Frank had not replied to my emails but had organised for my locum shifts to be cancelled. I was expecting Frank to be at the clinical meeting that morning, but he was not present. I had to speak to Ms Friis alone. As I had lost trust in Ms Friis, I asked for a receptionist Ellie and Kirsty Edwards to be present. (Kirsty could not attend). I asked Ms Friis why my locum sessions had been cancelled. She said, “I’m not going to say, you’ll have to speak to Frank.” I asked where Frank was, she said he was not coming in and then got up from her chair and moved towards me, saying “I’m not going to do this love, you have to speak to Frank, love”. (Mann, para 61) 3.161. Ms Friis produced a note of the meeting of 3 July, in which she agrees that she refused to discuss the cancellation of the sessions and that they should wait until Frank was available. On Dr Mann insisting, she reports finally saying “It’s because we can’t afford it” (197.2 ) 3.162. Her note includes an account of some of the other incidents, including with Mohima. 3.163. Ms Friis ends, having explained that Mohima was allowed to leave without working her notice, “In retrospect I was not sure what to do and felt that we were so desperate for GP appointments that it was more beneficial to go with Dr Mann’s demands.” 3.164. She does not mention that Mohima resigned having had a disciplinary hearing and facing a further disciplinary hearing in relation to misconduct in relation to handling a prescription and rudeness to Dr Mann. She does not mention that Mohima was agreed to have made a false allegation against Dr Mann and that that was the reason she was allowed to leave without working her notice. 3.165. She adds that, “We gave her a good reference.” 3.166. Ms Friis adds an account of the difficulties in June when Dr Mulder was on annual leave and Dr Platford in hospital, “I asked Dr Mann if she could be duty doctor as well as seeing her patients and that I would have reception screen all calls so that only emergency on the day came to her. The reason I asked this of her is that at my previous practice on the call GP saw patients as well as seeing urgent on the day. I did the best I knew how which was very difficult with Sonia walking out a few times.” 3.167. This was the proposal that Dr Mann had earlier found so unacceptable in terms of patient safety, to use reception staff to determine what was an emergency, while Dr Mann continued with her booked clinic. There is no other reference in the evidence to Dr Mann “walking out a few times.” 3.168. Dr Mann left the surgery after this meeting. 3.169. Ms Edwards, who saw Dr Mann after the meeting, gave a written report later that day of what Dr Mann had told her after the meeting, namely, that Ms Friis had said “Frank needs to be here, love” and continually called her “love” through the short meeting. She reports too that Dr Mann was crying, and asked her to write this up, “I agreed to as I do feel this is quite significant. Dagma followed Sonia out into the car park but Sonia did not return. I did not find writing this easy and I will not take sides. I am writing this as requested by Sonia as she asked me to be witness to the conversation. I also feel it that it is the right thing to do as I believe these issues are becoming more and more frequent … As stated in my email previously, and I note I have not had a reply, I am struggling to feel completely safe and supported here at present.” (197). 3.170. Dr Mann sent a text message to Mr Laver at 9.05 that morning, “Hello, I am unable to work today or the rest of the week due to acute stress, palpitations and headaches. This was precipitated by an incident with Dagma this morning. The attitude she displayed towards me is unacceptable. I have to question what is going on here and why. Is this because I have asked for a grievance meeting? I have a GP appointment on 15th July after which I …” (214, copy in bundle ends at this point). 3.171. Mr Laver replied, “Thank you for letting me know, Sonia, and I am really sorry to hear this. Regards Richard” (215) 3.172. Dr Mann sent a text message to Dr Mulder at 09.08 that day, in the same words as the message she sent to Mr Laver. The final words of this message are, “I have GP appointment on 15 July, after which I will provide a fit note. Sonia Please can you let me know when we can meet this week?” (158). 3.173. She then sent a further text to Mr Laver, “Can you liaise with Frank to organise this meeting as yet I have not had a reply to any of my emails sent since the beginning of June?” 3.174. Dr Mulder rang Dr Mann later that day. This was their first conversation since his return from holiday on Monday 1 July. 3.175. We have seen no contemporary note of that conversation from either. Dr Mulder does not deal with it in his witness statement. Dr Mann’s account was not challenged. 3.176. In her witness statement, Dr Mann says, “Our conversation began with Frank saying “I heard from Dagma that you have resigned”, I said “I think she would like me to but no I have not resigned”. Frank said “There are two ways this can go. If you were to resign, we would not need to go through the grievance meeting, or you could be off sick for 3 months.” “I said that I wanted to know what was going on and why had he cancelled my locum shifts. He would not say but said “Richard will be writing you a letter.” (Mann paras 67 and 68) 3.177. It was agreed that there would be a meeting between them that evening, at 6.30 pm. This was not to be the grievance meeting. This was to discuss more immediate issues. 3.178. Dr Mann arranged someone to accompany her. Dr Mulder asked Professor Feder to sit in, confirming that this was not the grievance meeting (191.5). Dr Mulder then changed the meeting from Friday evening to the afternoon of 8 July. 3.179. On 5 July, Dr Mann cancelled the meeting (158). She explains, “Because by that stage, I believed that the invoice, the whole locum shift saga was a ruse to intimidate me because I had made a disclosure about patient safety and had asked for a grievance and I felt I was in a toxic situation, so I withdrew, I had already, the day before that, I sent a text to say I was not going to attend the meeting and I did not make contact again with the practice again until my resignation on 19 July. So I did not respond. It was supposed to be 3 July. Frank moved it to 8th and by then I had lost all trust with the practice and was fed up and when I reflected on the events that had passed from 3 June to 3 July, the only conclusion was that this was a ruse to intimidate me, he was leading me down a path I did not want to go down, I wanted my grievance hearing but instead we were focusing on locum shifts and invoices, so I cancelled.” (oral evidence) Holly King List of Concerns regarding Dr Mann 3.180. On 5 July, Ms King produced a list of complaints about Dr Mann (198). It is headed “List of concerns regarding Dr Sonia Mann” 3.181. The complaints, some ten in all, cover some matters that have implications for patient safety. Those include failing to sign urgent prescriptions, refusing to call back patients if the patient misses a call, relying on reception to explain medical matters, transferring patients on to junior GPs lists. Others are about her manner, described as abrupt, or not being a team player. 3.182. There is a reference again to the incident of 7 June, “Dr Mann recently left a female receptionist in the building with a potentially dangerous patient and told the Receptionist to call Dr Mulder, who was actually on his annual leave.” 3.183. This is inaccurate and incomplete. Dr Mulder had not been on his annual leave at the time; Dr Platford’s involvement is not mentioned. In Ms King’s previous account, the receptionist had not been left alone. 3.184. There is a reiteration of the requirement that Dr Mann’s booked clinic was cancelled when there was no triage GP, “I feel that this is making unreasonable requests of the reception team.” 3.185. While the picture painted is of someone abrupt and rude, there is no reference to aggression and no mention of the March allegation when Dr Mann was accused by Mohima of threatening behaviour. 3.186. Neither Ms Friis nor Dr Mulder remember getting this list. There was no investigation of the matters raised. It was not recognised as raising a concern under the whistleblowing procedure. No action was taken on it. 3.187. On Sunday 6 July, Mr Laver wrote to Dr Mann, copying in Dr Mulder, in the expectation that the meeting on 8 July would be continuing. It addresses locum pay rates. “First of all, I am really sorry that your relationship with Helios seems to have change so dramatically during the last few months. I believe I am correct in saying that you joined the Practice in June 2015 And, in the almost four years I worked with you, whenever had a “cross word” or disagreement.” 3.188. The letter sets out the agreement of £80 per hour plus a triage premium of £100. But he suggests that rather than the £80 being a true hourly rate, “My view is that any extra worked over and above a 4 hour session is covered by the “Triage Premium”. Could you please consider this before meeting with Frank.” 3.189. He said her interpretation of the agreed rate was unaffordable and substantially above charges made by others. He was also unhappy about the £50 penalty clause. 3.190. The email ends, “Sonia, nobody underestimates how good you have been for Helios during the last 4 years and I do sincerely hope that matters can be resolved on Monday.” 3.191. He adds, “I know that there was a problem with sessions being taken off screen last week and my view is that once the sessions have been agreed they should not have been removed.” (200) 3.192. On 19 July, Dr Mulder emailed Dr Mann, copying in Catherine Ward, He refers to the decline in Dr Mann’s working relationship with Helios over the last few months. He explains that Catherine Ward would be assisting in the management of Helios. He goes on, “One proposal is that you and Catherine meet to talk through your grievances. This conversation would be protected in that anything discussed or said would be completely off the record and not be repeated or used by either of you to anyone including myself. The aim would be to find a acceptable solution to the current situation for all concerned. This would be without prejudice. ….. I hope this will help to move things forward.” 3.193. Dr Man submitted her resignation three hours later. 3.194. The letter opens by stating that she is resigning, “forthwith in direct consequence and acceptance of your repudiatory breaches of my contract of employment. I consider that you have irretrievably broken the implied term of mutual trust and confidence between us….” (203) 3.195. There follows a detailed account of the difficulties arising on and since 11 June, identifying protected disclosures including in her email of 12 June to her clinical colleagues, the message of the same date to Dr Mulder, in her grievance and in her report on the evening of 13 June. She refers to the detriments of being left unsupported when Dr Mulder left the country and in the failure to address the grievance. She highlights the failure to provide adequate GP cover on 12 June, 14 June and 21 June. She refers to the proposal by Ms Friis for 21 June, and her report of it to the partners of the same day, “…even though there was to be no duty Dr the next morning (21st), she had not cancelled my booked clinic for the next morning. She instead offered to ‘tell patients there are no appointments and to call back on Monday’ and that any emergencies could ‘wait until the afternoon’. This concerned me deeply as to why she would even suggest this, as I had already stated on several occasions that this scenario would be unacceptable, as it was unsafe for both myself and our patients and placed me under extreme stress. It has never been accepted practice to work in this manner in the 4 years that I have been employed at Helios MC. I felt unsupported because my concerns were not being taken seriously. It was only when pressed that she finally agreed to cancel my booked clinic….” 3.196. Dr Mann points out that there was no reply from Dr Mulder, and Mr Laver had told her that he was unable to assist while on sick leave. Dr Mulder had called her. In that call, he had told her he had directed the cancellation of her locum sessions and was challenging her fees. The cancellation of the locum sessions on 3 June was the last straw and, it being the only time her locum sessions once agreed had been cancelled, a detriment directly related to the making of a protected disclosure. 3.197. She also reported that he had suggested that if she was to resign, no grievance meeting would need to take place, which she describes as a further a further breakdown of trust and confidence between them, an attempt to circumvent her statutory and contractual rights and evidence on noncompliance with the ACAS Code. 3.198. There had been, she said, no acknowledgement of the concerns she raised and no steps taken to hold a grievance meeting (203 – 206). 3.199. Mr Laver responded on 24 July 2019, in a kindly worded letter (209), accepting the resignation with regret, and offering again the without prejudice meeting earlier suggested. 3.200. He said, “ On behalf of the Helios team I thank you for your endeavours and we are sorry to lose you.” and, “As I said in my last email to you, you have been one of the mainstays of the Practice for the last 4 years and I was saddened to receive your letter of resignation. Whether you decide to meet with us or not please be assured that I will give you a good reference if you require one for any new post you may be considering.” Law Constructive Dismissal 4.1. An employee has a right not to be unfairly dismissed (section 94 Employment Rights Act 1996 (“ERA 1996”). 4.2. A termination of the contract by the employee will constitute a dismissal within section 95(1)(c) of the ERA 1996 if he or she is entitled so to terminate it because of the employer's conduct. That is a constructive dismissal. 4.3. For the employee to be able to claim constructive dismissal, the employee must establish that the following four conditions are met: i) There must be a breach of contract by the employer. ii) That breach must be sufficiently important to justify the employee resigning, or else it must be the last in a series of incidents which justify his leaving. iii) The employee must leave in response to the breach and not for some other, unconnected reason. iv) The employee must not delay too long in terminating the contract in response to the employer's breach, otherwise he or she may be deemed to have waived the breach and agreed to the variation of the contract or affirmed it. 4.4. A repudiatory breach of contract is a significant breach, going to the root of the contract (Western Excavating (ECC) Ltd v Sharp [1978] ICR 221). That is to be decided objectively by considering its impact on the contractual relationship of the parties (Millbrook Furnishing Industries Ltd v McIntosh (1981) IRLR 309) 4.5. It also follows that there will be no breach simply because the employee subjectively feels that such a breach has occurred no matter how genuinely this view is held. If, on an objective approach, there has been no breach, then the employee's claim will fail (see Omilaju v Waltham Forest London Borough Council [2005] EWCA Civ 1493, [2005] IRLR 35). 4.6. Employment contracts contain an implied term of mutual trust and confidence. The parties to the contract will not, without reasonable and proper cause, conduct themselves in a manner calculated or likely to destroy or seriously damage the relationship of confidence and trust which should exist between employer and employee (Malik v BBCI SA (in liq) HL [1998] AC 20). 4.7. It is not simply about unreasonableness or unfairness. The question is whether the conduct complained of was likely to destroy or seriously damage the relationship of trust and confidence. 4.8. it is not necessary in each case to show a subjective intention on the part of the employer to destroy or damage the relationship, a point reaffirmed by the EAT in Leeds Dental Team Ltd v Rose [2014] IRLR 8, EAT. As Judge Burke put it: ''The test does not require a Tribunal to make a factual finding as to what the actual intention of the employer was; the employer's subjective intention is irrelevant. If the employer acts in such a way, considered objectively, that his conduct is likely to destroy or seriously damage the relationship of trust and confidence, then he is taken to have the objective intention spoken of…'' 4.9. The Claimant must have resigned in response (or at least partly in response) to the Respondent’s breach of contract. The Tribunal must consider the five step test in Kaur v Leeds Teaching Hospital NHS Trust [2018] EWCA Civ 978,(1) What was the most recent act (or omission) on the part of the employer which the employee says caused, or triggered, his or her resignation?(2) Has he or she affirmed the contract since that act?(3) If not, was that act (or omission) by itself a repudiatory breach of contract?(4) If not, was it nevertheless a part of a course of conduct comprising several acts and omissions which, viewed cumulatively, amounted to a (repudiatory) breach of the Malik term?(5) Did the employee resign in response (or partly in response) to that breach? 4.10. The general principles of contract law applicable to a repudiation of contract are that if one party commits a repudiatory breach of the contract, the other party can choose either to affirm the contract and insist on its further performance or he can accept the repudiation, in which case the contract is at an end. 4.11. Delaying too long or, by conduct, indicating acceptance of the change, can point to affirmation. It is not contended by the Respondent that the Claimant affirmed the contract. Protected Disclosure 4.12. The provisions relating to protected disclosure are set out at sections 43A to 43K of the 1996 Act. 4.13. It is not disputed that the Claimant made disclosures of information. The contest primarily is over whether they were made in good faith, in the claimant’s reasonable belief and in the public interest. However, it has also been suggested that there was not sufficient information to identify a risk to 4.14. By section 43B, “In this Part, a “qualifying disclosure” means any disclosure of information which, in the reasonable belief of the worker making the disclosure, is made in the public interest and tends to show one or more of the following – (b) That a person has failed, is failing or is likely to fail to comply with any legal obligation to which he is subject… and (d) That the health of safety of any individual has been, is being or is likely to be endangered….” 4.15. By section 43C, a qualifying disclosure is made, where the worker makes the disclosure to his employer. 4.16. A qualifying disclosure will have sufficient factual content and specificity to be capable of pointing to one of the qualifying categories in section 43B (Kilraine v Wandsworth LBC [2018] EWCA IRLR 846). The Tribunal must take into account the context and background. There is no rigid distinction between the provision of information on the one hand and the making of an allegation on the other (Simpson v Cantor Fitzgerald Europe CA [2021] IRLR 238). 4.17. The tribunal also considered in Chesterton Global Ltd v Nurmohamed [2017] EWCA Civ 979CA , considering the public interest requirement. There are four factors to be taken into consideration: the numbers in the group whose interests the disclosure served; the nature of the interests affected and the extent to which they are affected by the wrongdoing disclosed; the nature of the wrongdoing disclosed and the identity of the alleged wrongdoer. 4.18. Guidance is given from Blackbay Ventures Ltd (Chemistree) v Gahir UKEAT/0449/12/JOJ on the steps to be taken by the Tribunal.[1]Each disclosure should be identified by reference to date and content.[2]The alleged failure or likely failure to comply with a legal obligation, or matter giving rise to the health and safety of an individual having been or likely to be endangered or as the case may be, should be identified.[3]The basis upon which the disclosure is said to be protected and qualifying should be addressed.[4]Each failure or likely failure should be separately identified.[5]Save in obvious cases if a breach of a legal obligation is asserted, the source of the obligation should be identified[6]The Tribunal must then consider whether or not the Claimant had the reasonable belief referred to in section 43B(1) and whether it was made in the public interest. 4.19. By section 47B(1), “A worker has the right not to be subjected to any detriment by any act, or any deliberate failure to act, by the employer done on the ground that the worker has made a protected disclosure.” 4.20. “Worker” has the extended meaning given by section 43K. 4.21. By section 47B(1A), “A worker (“W) has the right not to be subjected to any detriment by any act, or any deliberate failure to ack, done –(a) By another worker of W’s employer in the course of that other worker’s employment, or(b) By an agent of W’s employer on the ground that W has made a protected disclosure. 4.22. In such a case, the detriment is treated as done by the employer (section 47B(1B). 4.23. Where the Tribunal finds a protected disclosure and detriment, the question is whether on not the detriment was “on the ground that” the worker has made the protected disclosure. The question there is whether the protected disclosure materially influences (in the sense of being more than a trivial influence) the employer’s treatment of the whistleblower. (Fecitt and others and Public Concern at Work v NHS Manchester, [2011] EWCA Civ 1190, [2012] IRLR 64. 4.24. By section 103A, an employee is to be regarded as unfairly dismissed if the reason or principal reason for the dismissal is that the employee made a protected disclosure. The burden is on the Respondent to establish the reason for the dismissal (Kuzel v Roche Products Ltd [2008] ICR 799). If the employer fails to do so, it is open to the employment tribunal to find that the reason is that asserted by the employee, but it is not bound to do so. The identification of the reason or principal reason turns on direct evidence and permissible inferences from it. 4.25. We are referred to Salisbury NHS Foundation Trust v Wyeth, [2015] UKEAT/0061/15/JOJ. Where breaches of contract are found, it is for the Tribunal then to determine the reason or principal reason for that conduct. 5. Submissions 5.1. Both counsel presented written submissions which were helpful, and amplified them briefly in oral submissions. 6.[7]Findings in relation to the issues Constructive Unfair Dismissal 7.1. The issues are set out again for ease of reference. 7.2. The Claimant claims that the Respondents acted in fundamental breach of contract in respect of the express/implied term of her contract relating to pay/mutual trust and confidence. The alleged breach(es) were as follows: - 7.2.1. From 26 April 2019 onwards, failing to provide safe systems of work / creating risk of harm to Claimant and/or patients. The Claimant relies on the following alleged matters: -(a)26 April 2019 and/or 1 May 2019 – booking routine appointments into triage clinic(b)7 June 2019 – email from Claimant to the Respondents regarding inadequate time to perform administrative duties(c)11 June 2019 email and WhatsApp message to Respondents raising concerns relating to patient safety and inadequate levels of GP cover(d)12 June 2019 – email to the Respondents raising safety concerns relating to lack of triage provision(e)12 June 2019 – the matters referred to in the Claimant’s grievance to the Respondents(f)12 June 2019 – WhatsApp message to Mr Laver in which the Claimant raised concerns regarding alleged crisis situation in patient safety and(g)12 June 2019 – alleged inappropriate conduct by Ms D Friis 7.2.2. From 26 April 2019 onwards failing to provide safe systems of work thereby creating additional stress to the Claimant and risk of harm to patients. The Claimant relies on the following alleged failures: - (a) Insufficient GP coverage and (b) Expecting the Claimant to undertake excessive / unsafe levels of work (including expecting the Claimant to cover clinics with prebooked and emergent patients without any /any sufficient support) creating additional stress to the Claimant and risk of harm to patients. The Claimant relies on the alleged matters referred to at paragraph 7.2.1 above. 7.2.3. 12 June 2019 onwards – causing the Claimant extreme stress resulting in her being off sick on the following dates: - 12 June 2019, 17 June 2019, 21 June 2019 and 4 July 2019. 7.2.4. 12 June 2019 onwards – alleged failure to deal / deal adequately with the Claimant’s grievance dated 12 June 2019. 7.2.5. 3 July 2019 – alleged treatment of the Claimant by Ms Friis 7.2.6. 3 July 2019 – unilateral cancellation of locum shifts without prior consultation / explanation / the Respondent’s decision to challenge the Claimant’s invoice number 37. (The last of those breaches was said to have been the ‘last straw’ in a series of breaches as that concept is recognised in law). Safe system of work creating risk of harm to claimant and or patients. 7.3. On 5 and 7 June, Dr Mann expressed concern about the time available to do administrative work and holiday cover. On 11 June she reiterated concern about adequate cover, raising both workload and patient safety. On 12 June she raised concern about the inadequacy of GP cover and the failure to provide a safe system of work causing risk of harm to doctors and patients. That was because she was the only GP handling the surgery with singlehanded responsibility for a booked clinic and triage. The circumstances she complained of were repeated by failures to provide adequate GP cover on 14 June and again on her return after sick leave on 21 June. Her paperwork was not covered during her absence. She was expected to cover Dr Mulder’s paperwork, as he explains, without proper notification or consultation. 7.4. She was off sick from 14 to 19 June, again from 21 to 22 June. 7.5. There was adequate cover from 23 June to 3 July. She was at work. 7.6. The matters she complains of go directly to the health and safety of doctor and 7.7. She properly raised the issues in her grievance on 12 June, amplified on 18 June. 7.8. She pressed for the grievance to be addressed on 28 June and 3 July, but without response. She made clear her continuing concern about the failure to provide a safe system of work and risk of harm to patients. 7.9. The risk of harm to patients is clear. A stressed and exhausted GP Dr Mann gives an example of an instance when she heard that something in a patient’s condition that might have required urgent attention was possibly overlooked and she was prompted to reflect how it would be easy to overlook something under stress, pressure of work and fatigue Prescription requests are put forward by receptionists. We have instances in the evidence of receptionists giving way to patient pressure and putting in requests for a previous medication or a higher dose, or even for a new medication, with scope for error in the GP failing to check properly. Introducing obstacles in accessing prompt care The systems used to divert triage patients from the doctor running a fully booked clinic, should not have involved asking them to ring 111, but she tells us that it did. Patients were told by reception to ring 111 and were told by 111 to go back to the surgery, with notification from 111 to the surgery to call the patient back. A patient might face an unacceptable delay in securing advice or treatment or may misjudge the urgency, faced with barriers in accessing advice, with consequent harms. The same might arise by ill-judged or ill-informed assessments by reception of the urgency of the consultation, given that their options included deferring cases. The point of GP triage is to prevent those harms. The failure to address paperwork meaning that responding to lab results or providing prescriptions is delayed with potentially adverse consequences. That is implicit in the failure to arrange adequate GP cover, in particular in making inadequate arrangements for holiday cover. It is notable that while Dr Mulder says he arranged for Dr Mann to cover his paperwork while on holiday he did not consult her or tell her or arrange sufficient resources of time for her to do it or respond to her request that proper arrangements were put in place. However he did later, on 20 June, ask Ms Friis to notify Dr Mann that she was not responsible for other people’s inboxes, which again rases a question about arrangements for patient care. Dr Mann’s experience was that locums did not adequately cover it and had not all been trained to use the systems in place to do so. Ms Friis was expressly asking Dr Mann to show a locum colleague how to use the system at the meeting on 20 June. The failure to provide an overall safe system of work for all staff, placing reception staff under pressure and exposing GPs to inappropriate pressure from them. We have seen that in Mohima’s conduct and in particular in Ms King’s. The pressure in each case was to act in a way that was potentially harmful to patients. In each case it was persistent and renewed, and no corrective action was taken in the case of Ms King. Mohima was dismissed but allowed to leave on full notice pay and without a final disciplinary. Failure to provide safe systems of work causing stress and risk of harm 7.10. The Claimant relies on Insufficient GP cover Unsafe levels of work, including pre-booked and triage 7.11. We accept those for the reasons already given. Causing claimant extreme stress leading to her being off sick on various dates 7.12. There is a correlation between the days of maximum stress and the periods when Dr Mann was off sick. It is clear and agreed that she was under stress, the Respondent’s staff and partners recognising it. No other reason has been established. She has a previously good health record. The fit notes provided refer to “stress at work”. Failure to deal with the grievance 7.13. On 12 June, Mr Laver very reasonably considered that Dr Mulder would have to deal with the grievance. He himself was off sick, having given notice of retirement because a return to work was not possible. The issues related to clinical practice and Dr Mulder was the clinical partner. There was no response from Dr Mulder about it at any stage until after Dr Mann had stopped work on 3 July. The step then offered – a protected conversation with someone from outside the practice – was not in keeping with the grievance policy and cannot be seen as a step in the handling of a grievance. It does not help that the proposed individual, a manager from a nearby practice, was someone not known to Dr Mann and not properly introduced in that email. Importantly, the grievance related to GP work and patient safety, which were matters of Dr Mulder’s responsibility and that an external non-clinical consultant was not likely to be able to address. Unilateral Cancellation of Locum shifts 7.14. Dr Mann was emailed the cancellation of the locum sessions on 2 July. The email was sent to her NHS email address which she does not check on days when she is not working. She saw it on 3 July. No explanation was given. The cancellation was unexpected – there was no practice of cancelling agreed sessions. Mr Laver agreed that the sessions should not have been cancelled. 7.15. Dr Mann is a salaried GP. She supplements her service to the practice by locum sessions. The practice relied on her and salaried GPs to do that. The decision to cancel and the failure to consult or explain goes to trust and confidence in the working relationship, even though the locum services are not covered by the employment contract. Alleged treatment by Ms Friis 7.16. Dr Mann asked for the explanation for cancelling sessions she had agreed at the respondent’s request at the meeting with Ms Friis on 3 July 2019. Ms Friis agrees that she refused to discuss it and that she tried to show Dr Mann out. She agrees that she does use endearments, such as “love”. We accept Dr Mann’s account that she called her “love” in a way that was disrespectful and belittling. The challenge to the invoice 7.17. In respect of the invoice submitted for locum fees, Dr Mann’s written agreement for payment of locum fees supports the invoice. We have different versions from the Respondent of what the fees should have been but the invoice is supported by the agreement reached, one which the Respondent has acknowledged was made, and was within Ms Friis’ authority to make. 7.18. The decision to challenge the invoice based on that express agreement again goes to the question of trust and confidence. Locum work is intimately interconnected with the employed earner work, with salaried GPs a preferred point of call in order to secure continuity of service. 7.19. Mr Laver sets out the basis for the challenge, from his perception, in the letter of 6 July 2019. The dates of the matters claimed as the “last straw” are therefore 3 July and 6 July. In conclusion 7.20. Applying the law to the facts, we find there were a series of cumulative repudiatory breaches in the implied term of trust and confidence in the failure to provide a safe system of work, failure to address the claimant’s concerns including over patient safety, cancellation of locum sessions, the refusal to explain, the disrespect with which she was treated in the failure to communicate and in the conduct of Ms Friis and in the challenge to the locum invoice. 7.21. Did the Claimant resign because of the breach? 7.22. We accept that the Claimant resigned because of those breaches. She resigned promptly and expressly refers to the breaches in the grievance and in the resignation letter. 7.23. Did the Claimant delay before resigning and affirm the contract? 7.24. The Respondents did not rely on any argument of affirmation and it is clear that the resignation was prompt. 7.25. In the event that there was a constructive dismissal, was it otherwise fair within the meaning of s.98(1), (2) and (4) of the Act? The Respondents contend that if the Claimant was constructively dismissed (which is denied) that (a) The Claimant was fairly dismissed by reason of her conduct and / or that (b) She would, in the event of any procedural defects for the purposes of section 98(4) of the Act have been fairly dismissed if a fair procedure had been followed and /or (c) That the Claimant was, in any event, guilty of contributory conduct (in the light of the Claimant’s conduct). 7.26. The Claimant was not fairly dismissed by reason of her conduct. There was no fair procedure. She would not have been fairly dismissed if a fair procedure had been followed. No misconduct is established. The Respondent did not have a reasonable belief in her misconduct based on reasonable investigation at the time of her resignation. She was not guilty of contributory conduct. 7.27. The Respondent has failed to show a fair reason for the constructive dismissal. 7.28. This was an unfair constructive dismissal The Public Interest disclosure claims 7.29. These are the agreed issues. 7.30. What did the Claimant say or write? The Claimant relies on the following: 11 June 2019 – email and WhatsApp from the claimant to the Respondents dated 11 June 2019 raising concerns regarding patient safety and level of GP cover 12 June 2019 – further email and WhatsApp from the Claimant to the Respondents raising concerns regarding the level of GP cover 12 June 2019 – the Claimant’s grievance 13 June 2019 – emails from the Claimant to the Respondents raising concerns about alleged excessive levels of stress and responsibility placed upon her by the Respondents 21 June 2019 – WhatsApp message to the Respondents (Dr Laver) regarding the cancellation of triage (doctor first) clinics. 7.31. The disclosures relied on are set out in the primary Findings of Fact but are gathered here again for ease of reference: - 11 June “Hi Frank, I understand Joan is off sick with stress this week. I have sent an email regarding paperwork cover. I explained to Dagma I’m not accepting responsibility of covering all paperwork for yourself and Joan as I can just about keep up with my own. Sonia.” (157) “Maybe I’m not making myself clear. It’s not only about work load but more importantly about patient safety. I take it that you’ll be remotely accessing results so nothing important slips the net.” (157) 12 June “Today I arrived at work to find no triage Dr booked and I have a booked clinic. I asked Holly to cancel my booked clinic to which she replied “no” and then walked out of the practice. I have seen there is no cover doctor booked for Friday. I understand Frank left for Greece yesterday, despite the practice left the way it is. Joan is off sick this week. This situation is unacceptable and unsafe. I have spoken to both Richard and Dagma today. Dagma states she has tried to get locums but failed, however there has been no adverts on BASD (Bristol Association of Sessional Doctors) and no one has yet contacted Gene or Louise who apparently have said they could cover a Thursday or Friday. There is no clear plan who is responsible for paperwork/labs etc. I’ve been told “just do what you can”. This again is a patient safety concern. I am the only doctor here left to deal with the whole patient population with no clear idea about locum cover and work load cover. I feel it is unsafe to continue to practice under these circumstances as it poses a high risk of potential harm to patients. I understand Dagma is trying to get hold of Frank (I have texted him) and will contact Richard so the CQC can be informed.” I feel it is unsafe to continue to practice under these circumstances as it poses a high risk of potential harm to patients.”(184) 12 June - Grievance “I request a formal grievance meeting to discuss: Lack of support by the Partnership in my role as a Salaried GP Unsafe working within the practice which has been highlighted on several occasions with ineffectual resolution ie lack of adequate action about concerns raised. Risk to patient safety Poor communication amongst staff members No response to last email regarding pay appraisal. (182) 13 June “I am being placed under unreasonable stress and expected to shoulder responsibility as if I was a Partner…. Still no cover tomorrow from Duty GP from 9 am until 11.20 am when Gene has been booked to arrive. I have a fully booked clinic from 9 am This situation is causing me considerable stress, I have had migraines all week and I cannot be expected to work under these conditions” (186) 21 June “Dear Richard, Dagma yesterday proposed to me that there should be no triage GP and I could still have my booked clinic. She said “other practices do this” and that she will man the front desk and tell patients there is no doctor and to call back on Monday. She said this was discussed with you Richard. This is despite my emails and conversations about how unsafe I felt this scenario would be and a condition for my return to work. Why would she even propose this? She eventually changed my clinic to a triage and cancelled my booked surgery after I said it was unacceptable. I feel there is no real support or trust here. I will not be working today due to the stress of this so please let the practice know. I will discuss this with my own GP and provide a further note on Monday. Sonia” (248) 7.32. The next issue is, in any or all of these, was information disclosed which in the Claimant’s reasonable belief tended to show that: - The health of safety of any individual, including the Claimant, other members of the Respondent’s staff and / or patients had been put at risk as a result of alleged unsafe working practices / understaffing operated by the Respondents Or that any of those things were happening or were likely to happen, or that information relating to them had been or was likely to be concealed? 7.33. The messages are specific, clear, sufficiently factual and specific. Information is disclosed. 7.34. We are satisfied of the Claimant’s reasonable belief in what she was disclosing and that it indicated risk to patients and GPs. Her reports address unsafe working practices that had happened, were happening and were likely to be happening again in that there was inadequate GP cover for both paperwork and patient consultations and previous alerts had been disregarded. 7.35. Each raises the issue of patient safety expressly or by clear implication. The safe operation of a medical practice is a legal obligation. Failure to provide sufficient medical cover imports risks to the health and safety of patients. The last four disclosures raise the issue of the health and safety of the GP, that is, raising concerns about the safety for employees of the practice system of work. 7.36. To take the final disclosure as an example, that of 21 June, Dr Mann very plainly expresses her concern about how unsafe for patients the proposal made for their care was. This had been her repeatedly expressed view. Mr Laver was unable to deal with it and referred her back to Ms Friis. Ms Friis was the person whose decisions were in Dr Mann’s professional opinion, failing on a day-to-day basis to secure adequate arrangements for GP cover. 7.37. The Grievance itself is brief, but the context of previous emails and messages makes it very clear and it was in any case amplified in the further comments sent on 18 June, some six days later (188.2). 7.38. It is surprising to see a challenge made on the basis that the risk to patient safety was not made clear (Mulder, para 5). Inadequate GP cover and inadequate attention to emails, prescriptions and lab results self-evidently carry risks to patient safety. This deal with more fully above. This is a practice that serves 5,000 people and has responsibility for patient care including routine care and emergency responses during normal working hours. The risks Dr Mann was referring to did not need further amplification. 7.39. Going back to the issues, the next is: if so, did the Claimant reasonably believe that the disclosure was made in the public interest? The Claimant relies on the following as going to show the reasonable belief: - The safety of patients under the care of the Respondents was at risk. The health and safety of others in the employment of the Respondents was placed at risk. The disclosures included concerns relating to doctors (the Claimant’s working hours). 7.40. The account she gave over the history of those emails and WhatsApp messages is consistent, clear, well set out too in her resignation statement and witness statement, reiterated in her oral evidence. We are wholly satisfied of her belief in her disclosures and that they were made in the public interest for the pleaded reasons. She was raising with her employers legitimate concerns about the safety of patients and the health and safety GPs in employment at the respondent. 7.41. We accept all those pleaded as being protected disclosures. Detriment complaints 7.42. The issue here is, was the Claimant, on the ground of any protected disclosure found, subject to detriment by the employer or another worker in respect of any of the following:- 3 July 2019 – alleged unilateral cancellation of the Claimant’s locum sessions by Dr Mulder (without consultation or explanation) 3 July 2019 – alleged unprofessional and disrespectful conduct towards / treatment by Ms Friis when the issue of the unilateral cancellation of the locum shifts was raised by the Claimant 12 – 19 July 2019 – failure to deal promptly or at all with the Claimant’s grievance (Dr Mulder and / or Mr Laver). 7.43. The Respondents deny any of the alleged detriments. The Respondents do not rely on the statutory defence in respect of any proven detriments. 7.44. The detriments pleaded, as set out are established. The most important is the failure to deal with the grievance, which, if properly and promptly addressed could have led to the situation being resolved. 7.45. Addressing the causal relationship between those proven disclosures and those proven detriments, we do not have any sufficient reasons established by the Respondent for their actions. It is for the Respondent to show that the protected disclosures were not a material influence on what they did. 7.46. Both Dr Mulder and Mr Laver attribute the deterioration in the relationship with the Claimant to June 2019, and specifically to the period from the making of her protected disclosures, 11 June onwards. The natural inference is that the reason for the deterioration was the Respondents’ reaction to those 7.47. In our judgment, the detrimental treatment of the Claimant from June arose in a context in which those disclosures played a significant part. Dr Mulder and Ms Friis were both challenged personally in her criticism of the arrangements, Dr Mulder for going on holiday having made inadequate arrangements for the staffing of the surgery and implicitly for his view of what adequate arrangements would be, and Ms Friis in her failures to find and book locum cover or to understand the deep mistrust Dr Mann was expressing as to the adequacy of the arrangements she was making. 7.48. Ms Friis cancelled the locum work on 2 July. The pleaded response gives as the reason for cancelling the locum shifts that Dr Mann was unreliable. We do not have evidence of that. The sessions she did not attend were those when she was concerned about the safety of the arrangements for her work and the stress of that and the undue level of demands on her. When she did not attend, it was on the grounds of her health. There has been no evidence of unreliability other than on health grounds, in the last few weeks of her employment. Nor was this the reason given in evidence. 7.49. Ms Friis gave no reasons at the time and no satisfactory reason has been given since. Various reasons have been proposed aside from the suggestion that Dr Mann was unreliable: that she was too expensive or that she was overcharging over and above the agreed fees, that locum time had been booked out to training. It is hard to see any as the probable reason – Dr Mann’s invoice reflected the agreement over fees and addressing any concerns over it did not require cancellation of booked sessions, there was one query from Ms Friis about locum time and training which was not followed up. We know from Mr Laver that it was not normal practice to cancel agreed sessions and the evidence shows too plainly the difficulty the surgery had in getting enough locum cover. There would need to be a good reason for cancelling. 7.50. Dr Mann had been raising her concerns in each of her protected disclosures with added urgency. 7.51. Key here is her concern over safety of the arrangements. From 11 June, she was persistently challenging the arrangements made for her work over their safety, including with a suggestion that report to the CQC was appropriate and necessary. 7.52. Her view of this and the guidance she gave was not accepted. 7.53. Dr Mulder remained out of the picture. 7.54. Ms Friis persisted in not understanding or rather not accepting the approach to take. She went on with inappropriate suggestions contrary to Dr Mann’s guidance. Dr Mann increasingly mistrusted her. Of course, the guidance that should matter here is that of the doctor on duty. Dr Mulder was away and Mr Laver was leaving matters in the hands of Ms Friis. The consequence is increasing breakdown in the working relationship between Dr Mann and Ms Friis. 7.55. The final protected disclosure is that of 21 June, when Dr Mann again reported to Mr Laver that the arrangements for 22 June were unsafe. He undertook to tell the surgery that she would not be coming in, having confirmed that Ms Friis was in charge there. 7.56. We do not have evidence of what happened next. It is a necessary inference that Mr Laver reported that text message exchange to Ms Friis, in telling her that Dr Mann would not be coming in. It is a reasonable inference, more than reasonable, that he explained enough to show that Dr Mann was persisting in her view that the arrangements made were unacceptable to her. 7.57. Ms Friis’ notes of the discussion on 20 June show her reluctance to accept what was being said. She made the same proposals for 21 June that had been so roundly rejected as unsafe on 13 June and earlier. 7.58. We are not aware that she was getting any guidance. 7.59. Mr Laver should have known that she was suggesting that week what she had suggested the week before, but he was off sick and this was beyond what he could deal with. 7.60. It is inescapable that the cancellation of the locum clinics by Ms Friis on 2 July arises from the breakdown of the relationship between Dr Mann and Ms Friis and that that in turn arises out of the protected disclosures which are based on the inadequacy of the arrangements that Ms Friis makes in the light of Dr Mann’s concerns over safe management. 7.61. Ms Friis may have been out of her depth. But at that point she apparently had no guidance from her employers. The concerns raised in the grievance had not been addressed. 7.62. The alternative interpretation is that Dr Mulder told her to cancel the sessions – though it is not clear why she then denied it. If it was Dr Mulder’s decision, that tells us that her employers were content with the arrangements Ms Friis was making and did not accept the genuineness of Dr Mann’s concerns. Anger about the concerns being raised seems the only explanation for Dr Mulder’s failure to discuss matters on his return with Dr Mann. 7.63. For whatever reason, Ms Friis persisted in the arrangements that Dr Mann condemned as unsafe and which are the basis for the protected disclosures. If she knew of the unhappiness of her principals at that time with the invoice, that too would have come as a challenge to her management, given that she had agreed the rates charged. That too goes to the working relationship between her and Dr Mann. 7.64. In our judgment, Ms Friis cancelled the locum sessions in the light of the breakdown in their working relationship, following the repeated reports of Dr Mann which challenged her management, as only too fully exposed in the messages from 11 June and later, culminating in the meeting of 20 June and the messages of 21 June. Without those disclosures, the locum sessions would not have been cancelled. The various reasons put forward by the respondent are not coherent and in our judgment are designed to provide a smokescreen. 7.65. The conduct of Ms Friis in the meeting of 3 July can only be attributed to the breakdown of the working relationship. The cancellation of the locum sessions was her decision, and she was refusing to explain or justify it. She behaved in a disrespectful manner, sadly not inconsistent with the general attitude of administrative staff in this practice, again prompted by repeated challenges to her management in the content of Dr Mann’s concerns. 7.66. The grievance is one of the protected disclosures. 7.67. There were two reasonable options open to Dr Mulder when that was lodged. One was to set in hand the grievance procedure or at least to acknowledge it and set a timetable. The other was to contact Dr Mann to acknowledge her concerns and set about addressing them or setting a timetable to do so. 7.68. Surprisingly, he did neither. There is no contact that he initiates to Dr Mann from 12 June until 3 July when he spoke to her after the meeting with Ms Friis. She had asked for the grievance to be dealt with on 28 June and again on 3 July. He still did nothing to advance the grievance. The meeting on 8 July was not to be about the grievance and he did not speak to Dr Mann about using that meeting to set in hand handling the grievance when they spoke on 3 July. 7.69. No steps were taken on the grievance. 7.70. We have to consider why there is no response. Why was the grievance not addressed at all? 7.71. We have to look at Dr Mulder’s conduct during his holiday and on his return. Dr Mann had expressed urgent concerns. He had worked with her for four years and had had sufficient confidence in her to offer a partnership. Yet he did not acknowledge her concerns or contact her to offer reassurance even on his return. 7.72. In our judgment, Dr Mulder was angry and dismissive of the protected disclosures, of the allegations of unsafe practices. 7.73. He identified Dr Mann as the problem because she could not cope, not that the practice was unsafe. That is borne out by his enquiry later in September or October into patient throughput, an analysis conducted after her resignation, when her performance was not a current issue. 7.74. He reports that he proposed to clear the air at the meeting intended for 08 July, but not by addressing the protected disclosures. This was to address other issues. 7.75. The nearest that he comes to addressing the grievance is the offer of a protected discussion with someone from another practice. Dr Mann didn’t know who that person was. It was not another GP and it was not someone who had the authority to address the issues she raised. That proposal from Dr Mulder did not address the grievance. He was avoiding the issues raised in the disclosures. 7.76. Dr Mann’s account was unchallenged. She says that on speaking to her on 3 July, that he said in effect, “You can resign or go off sick”. He does not address this in his witness statement and his comment was that he did not think he put it in quite that way. He did not dissent from it. 7.77. The effects of his actions were to give her exactly that choice – what he offered was not a resolution. He did not offer to deal with the grievance or to address the concerns she raised. 7.78. When he next wrote to her it was to suggest a meeting with someone who was unable to address the issues she raised. She was entitled to conclude that he was not going to deal with the grievance or the protected 7.79. That avoidance and prevarication leads us to conclude that he failed to deal with the grievance because of the protected disclosures. His response to the disclosures was to identify Dr Mann as the problem and so he did not deal with the issues she raised. 7.80. Of particular note is the oral evidence of Mr Laver and Dr Mulder that the deterioration of the working relationship was only after the claimant’s disclosures and grievances, that is, from 11 or 12 June 2019. The necessary inference for the Tribunal is that without those disclosures and the later disclosures, the working relationship might have survived, particularly in the light of Dr Mulder’s view that even in July, it was not impossible that working relationships might yet be restored to the level of trust and confidence enjoyed in 2018. Mr Laver’s fair tribute on 6 July points the same way. 7.81. We conclude that the detriments were on the grounds of the protected Unfair dismissal complaint pursuant to section 103A of the Act 7.82. We have found that Dr Mann was constructively dismissed. 7.83. We did not in so doing find a reason for the dismissal. We have found that the Respondent has not proved a reason. 7.84. The remaining issue in relation to section 103A have been identified as follows: Has the Claimant produced sufficient evidence to raise the question of whether the reason for the dismissal was any of the alleged protected disclosure(s)? 7.85. The question is one clearly raised by the evidence that concerns arose only on the making of the protected disclosures. 7.86. We then have to consider the reason behind the Respondent’s conduct. It is hard to rationalise behaviour that is unexplained, and in itself shocking, conduct that defies belief. 7.87. Dr Mann left because of the breaches and the failure to address the grievance. Within the grievance is one of the protected disclosures. 7.88. In our judgment, the Respondents gave the protected disclosures no credence. They did not accept that her concerns were well founded. They did not recognise why this was a serious matter. 7.89. It was that failure to recognise the seriousness of the situation or to respond to the protected disclosures including that contained in the grievance that led directly to the resignation for the breaches of contract we have found. 7.90. The reason for the dismissal must be the protected disclosures. It is that Dr Mann refused to work in system she saw as unsafe, she was entitled to refuse and the Respondents were not prepared to do anything about it and were unhappy at her challenge. 7.91. In the defense of this claim, there has been a blanket denial of breaches of contract, pervasive, vitriolic and untrue attacks on the claimant’s conduct and credibility, inconsistencies leading to obfuscation, evasion, failures of disclosure and false evidence. All that goes strongly to support the conclusion that the real reason for repeated breaches of contract were the fact that the claimant was challenging the way the surgery was run. The Respondents were unhappy with that challenge, without giving it weight. 7.92. The principal reason for the constructive dismissal was indeed the protected disclosures. Breach of contract 7.93. The issue here is, “Is the Claimant entitled to any notice of pay in respect of the Respondents’ alleged repudiatory breaches of contract /consequential alleged constructive dismissal?” 7.94. It follows from our findings that the Respondents are in breach of contract and that this was a wrongful dismissal. Other matters 7.95. Amongst the list of issues, time limits were raised. That was not pursued in the Respondent’s closing submissions but in any event, having regard to the ACAS dates, we do not find the claims to be out of time in respect of either the unfair dismissal or the protected disclosures from 11 June, the more so given conduct extending over the following period. If we are wrong on that and for the avoidance of doubt, we find it just and equitable to extend time having regard to all the circumstances including the claimant’s health at the time, the difficult circumstances leading up to her resignation including the respondent’s conduct towards her 7.96. There was an opening statement in the Response that the claims were misconceived in their entirety and strike out was invited, a proposal put with some vigour. It will be clear from that the claims were not misconceived and that contention was misplaced. 7.97. Other claims pursuant to sections 44(1)(c) and/ or 100(1)(c)of the Act (health and safety detriment/ dismissal were not pursued, oral judgment having been given as above. At this stage of the case, neither withdrawn nor dismissed. That can be resolved on the final conclusion of the case.[1]The application was made just before the hearing listed to be on 27 March 2023 as the final hearing on remedy, which could not proceed.[2]It is in the interests of justice to consider the application notwithstanding that it is made outside the time limit in Rule 71. That is because it corrects the position and makes the handling of complex pension calculations more practical.[3]It was agreed that the application would be considered in chambers with the full panel, provision being made for written representations.[4]It is the agreed position that the employee pension contributions are not to be added back in finding net pay given that the assessment of remedy involves approaching future pension loss on a complex basis, contrary to the position adopted in the Judgment. That is to avoid double recovery in respect of those pension contributions.[5]It is agreed that in the calculation of actual earnings in the period ending 11 March 2022, the figure of 48 weeks should have been used instead of 43 weeks.[6]However, it is further ordered, that as settled between the parties, the finding of actual net earnings up to 11 March 2022 should be replaced by a finding up to the end of the actual financial year, 5 April 2022, based on the claimant’s tax return. That is because the period of past loss runs over a number of years and it is preferable to operate within financial years.[7]For ease of reference, the full terms of the revised judgment are set out below.[8]For the calculations, the source is the Opening Note, supported by the earlier Reasons, the Claimant’s Calculation of Earnings and Loss dated 20 March 2023 and her witness statement of 13 March 2023 and the Respondent’s Counter Schedule of Loss.[9]The Tribunal did not address paragraphs 11 to 14 of the application in the Opening Note. That application, if pursued, must be considered at the oral hearing listed for November 2023. JUDGMENT following RECONSIDERATION The effect of reconsideration is shown in red and underlined. The hearing is adjourned, pursuant to the claimant’s application, for further evidence and submissions, to consider in particular future loss and pension loss. The following are the findings of the Tribunal far. Findings In respect of the claim for detriment on the ground of protected disclosures contrary to section 47B of that Act, the Tribunal proposes an award of £31,500 in respect of injury to feelings, inclusive of aggravated damages. Further submissions are invited on the question of taxation and grossing up. Past financial losses have been calculated to 5 April 2022 but continue. The Tribunal has not determined the ACAS uplift or interest. The Tribunal has made the following findings: Notice pay nil – fully mitigated Detriment Injury to feelings £21,000 Aggravated damages £10,500 Unfair dismissal Basic award (4 years x 1.5) £3,150 Loss of statutory rights £1,300 Past losses to 5 April 2022 2019/20 £3598 2020/21 £7228 2021/22 £4310 Total £15,136 Past losses to 5 April 2022£13,805 A further calculation will be required for the final hearing The calculation and future losses are based on the following 20 July 2019 to 31 January 2022• Dr Mann would have secured salary of £9,000 per session for four sessions per week from 20 July 2019• Locum earnings are to be included in the calculation of losses• Locum work would have been negotiated to be £80 per hour with no triage premium from 20 July 2019, over sessions lasting four hours.• She would have worked some 26 four-hour sessions per annum on that basis• Locum earnings would have been £8320 per annum, before expenses or tax/national insurance (“NI”).• Self-employed earnings would be based on expenses at 9.69%• Self-employed earnings would be pensionable. 1 February 2022 to 31 December 2024• Dr Mann would have secured salary of £9,400 per session for five sessions per week from 1 February 2022.• She would have earned £4,160 in locum fees, before expenses or tax/NI.• Self-employed earnings would be based on expenses at 9.69%.• Self-employed earnings would be pensionable. 1 January 2025 to 31 December 2030• Dr Mann had a 75% chance of securing a GP partnership role by 1 January 2025.• She would not have undertaken locum work as a GP partner.• She had a 25% chance of continuing as a salaried GP for a further five years.• As a salaried GP, she would have had salary increases.• As a salaried GP, her locum work would have continued as above, but her fees would by 2025 have been re-negotiated.• Self-employed earnings would be pensionable.• Expenses on self-employed earnings would be 9.69%. From 1 January 2030• By 1 January 2030 Dr Mann will again have achieved the status and associated remuneration levels that she had planned to achieve by January 2025.• There will be continuing losses including to pension because of the set back to her career and the associated financial losses over the whole period. The level of the ACAS uplift has not been considered in relation to the financial losses, because the overall level of the award requires to be taken into account in assessing the just and equitable sum.