“Concerns about the capability of a doctor or dentist may arise from a single incident or a series of events, reports or poor clinical outcomes. Advice from the NCAA will help the Trust to come to a decision on whether the matter raises questions about the practitioner’s capability as an individual (health problems, behavioural difficulties or lack of clinical competence) or whether there are other matters that need to be addressed. If the concerns about capability cannot be resolved routinely by management, the matter must be referred to the NCAA before the matter can be considered by a capability panel (unless the practitioner refuses to have his or her case referred). Employers are also strongly advised to involve the NCAA in all other cases particularly those involving professional conduct”
“The assessment identified many examples of good practice. These included above average levels of documentation in medical records and clear examples of good process of obtaining informed consent. Overall, the assessment revealed patients undergoing a range of colorectal surgery to have been subjected to appropriate processes (algorithms) of investigation and management in a manner that reflected national practice. In general these processes were timely. It was clear that Mr Gryf-Lowczowski is hard working with a very significant commitment to patient care. Audit data indicates that Mr Gryf-Lowczowski’s mortality and conversion rates are in line with his peers’. However, there has been a level of concern expressed with regard to Mr Gryf-Lowczowski’s performance of cholecystectomy. Mr Gryf-Lowczowski explained why it was that he had undertaken open cholecystectomy although this seemed other than best practice. Despite this explanation the assessors remain concerned that Mr Gryf-Lowczowski has undertaken open cholecystecomies when it was not appropriate to do so. Mr Gryf-Lowczowski has agreed not to undertake further procedures of this kind at Hinchingbrooke and the assessors’ view is that this is a correct decision in the light of the available clinical evidence. The assessors feel that Mr Gryf-Lowczowski should concentrate on colorectal surgery and not undertake upper gastro-intestinal work. Mr Gryf-Lowczowski is slower than the assessors would expect when carrying out routine operations. Mr Gryf-Lowczowski has by now been out of clinical practice for approximately ten months at the time of the writing of this report, and, whatever the other findings of this assessment, will require clinical re-entry training before he can be considered as safe to practise.”
“The following recommendations are put forward by the NCAA as the basis of an action plan to be developed and taken forward by the referring organisation and doctor: Prioritised recommendations for the doctor 1. Mr Gryf-Lowczowski should not undertake either laparoscopic or open cholecystectomy. 2. Mr Gryf-Lowczowski should undertake a clinical re-entry package to allow his safe return to work and to address the concerns set out in this report. This re-entry package may include the following components: • Re-skilling at another Trust approved by the RCS for a period of between 6-12 months in the field of colorectal surgery including colonoscopy • A supervisor • A mentor • A formal “signing-off” by RCS approved trainer • Good practice in the training of junior staff • On-going review of performance at regular intervals 3. Mr Gryf-Lowczowski should not undertake any complex colorectal surgery until the successful completion of the clinical re-entry package has demonstrated that he is fit to do so. 4. Mr Gryf-Lowczowski should undertake training or other structured interventions to help him manage his anger, to improve his influencing skills and be more inclusive of his colleagues. Prioritised recommendations for the Trust 1. The trust should support Mr Gryf-Lowczowski in undertaking the above recommendations. 2. The Trust should undertake an urgent review of the structure, organisation and establishment within General Surgery. 3. The Trust should invite an appropriately qualified expert from outside the Trust to undertake an independent appraisal of the application and effectiveness of its management procedures as they relate to clinical and medical staff. 4. The Trust should arrange for a facilitated meeting (or series of meetings) to explore the breakdown in working relationships and how this can be addressed to achieve successful re-entry into the workplace”
“This may involve a series of meetings between the practitioner, employer/contracting body, the NCAA case manager and the NCAA adviser. If training placements are needed following the NCAA assessment, these will need to be arranged through the Deaneries and Royal Colleges with the help of the NCAA. The employer/contracting body is responsible for implementing any recommendations and for ensuring that the arrangements for signing off the completion of the programme have been fulfilled”
“Frustration of a contract takes place when there supervenes an event ‘without default of either party and for which the contract makes no sufficient provision’ which so significantly changes the nature (not merely the expense or onerousness) of the outstanding contractual rights and/or obligations from what the parties could reasonably have contemplated at the time of its execution that it would be unjust to hold them to the literal sense of its stipulations in the new circumstances; in such a case the law declares both parties to be discharged from further performance”
“1. The doctrine of frustration was evolved to mitigate the rigor of the common law’s insistence on literal performance of absolute promises. The object of the doctrine was to give effect to the demands of justice, to achieve a just and reasonable result, to do what is reasonable and fair, as an expedient to escape from injustice where such would result from enforcement of a contract in its literal terms after a significant change in circumstances. 2. Since the effect of frustration is to kill the contract and discharge the parties from further liability under it, the doctrine is not to be lightly invoked, must be kept within very narrow limits, and ought not to be extended. 3. Frustration brings the contract to an end forthwith, without more and automatically. 4. The essence of frustration is that it should not be due to the act or election of the party seeking to rely on it. A frustrating event must be some outside event or extraneous change of situation. 5. A frustrating event must take place without blame or fault on the side of the party seeking to rely on it.”
“I would finally observe that, in my view, this is not a case of frustration as that term is understood in the law of contract. The Appellant’s suspension from the register was not an unforeseen or unprovided-for event brought about by legislation or otherwise but (as erasure had always been) was a contemplated misfortune the effect of which was clearly preordained”
“First, that the court must guard against too easy an application of the doctrine, more especially when redundancy occurs and also when the true situation may be a dismissal by reason of disability. Secondly, that although it is not necessary to decide that frustration occurred on a particular date, nevertheless an attempt to decide the relevant date is far from a useless exercise as it may help to determine in the mind of the court whether it is really a true frustration situation. Thirdly, that there are a number of factors which may help to decide the issue as they may each point in one or other direction… (i) the length of the previous employment; (ii) how long it had been expected that the employment would continue; (iii) the nature of the job; (iv) the nature, length and effect of the illness or disabling event; (v) the need of the employer for the work to be done, and the need for a replacement to do it; (vi) the risk to the employer of acquiring obligations in respect of redundancy payments or compensation for unfair dismissal to the replacement employee; (vii) whether the wages have continued to be paid; (viii) the acts and the statements of the employer in relation to the employment, including the dismissal of, or failure to dismiss, the employee; and (vix) whether in all the circumstances a reasonable employer could be expected to wait any longer. To these we would add the terms of the contract as to the provisions for sickness pay, if any, and also a consideration of the prospects of recovery. Fourthly… the party alleging frustration should not be allowed to rely upon the frustrating event if that event was caused by that party – at least where it was caused by its fault”
“… I asked [counsel for the employer] what relevance the Defendant’s lack of trust and confidence in the Plaintiff’s capability to do his job had to do with the workability of the paragraph 41 procedure if ordered by the court. He was unable to give me an answer that convinced me that it had any relevance. In my judgment there is no rule of law or practice which prevents me from giving the relief sought if the circumstances of this particular case merit it, applying the principles enunciated in American Cyanamid v. Ethicon[1975] AC 396 , 507. As there was much discussion in argument about the evidence of loss of trust and confidence, it is right that I should refer to it; indeed, [counsel for the employer] went so far as to suggest that the Defendants had no genuine belief that they lacked trust and confidence in the Plaintiff’s capability to do his job. The Plaintiff was being made a scapegoat for the consequences of the interest swaps. Although it is not for me to make any findings of fact in these interlocutory proceedings, there is ample evidence that the Defendants’ assertion is genuine and there is very cogent evidence of loss of trust and confidence”
“I now conclude as to why in my judgment, the Plaintiff has established that he is entitled to the injunctive relief sought… (3) Without the injunction sought, the Plaintiff has lost the opportunity of ventilating his case and justifying himself at the hearings and enquiries under the paragraph 41 procedure… (5) Injunctive relief now restores the Plaintiff to his position and entitlement to the paragraph 41 procedure which the Defendants unlawfully deprived him of in the last week of July 1990”