HEARING HEARD IN PUBLIC HOPKINS, Aileen Registration No ...

HOPKNS, A Professional Conduct Committee – May 2019 Page -1/26-

HEARING HEARD IN PUBLIC

HOPKINS, Aileen

Registration No: 49018

PROFESSIONAL CONDUCT COMMITTEE

MAY 2019

Outcome: Erased with immediate suspension

Aileen Hopkins, a dentist, was summoned to appear before the Professional Conduct Committee on 14 May 2019 for an inquiry into the following charge:

Charge (as amended on 11 March 2019):

“That, being a registered dentist:

1. In the period subject to the allegations below you were practising in general dentistry as the owner of [redacted]

2. You provided care and treatment to the patients set out in Schedule A1.

Inadequate care/ record keeping

3. You failed to provide an adequate standard of care in that:

a. You did not adequately update the current medical history in respect of:

i. Patient 2 between 6 January 2011 and 28 March 2015;

ii. Patient 3 between 1 May 2012 and 31 May 2015;

iii. Patient 4 between 3 February 2011 and 5 August 2014;

iv. Patient 5 between 3 June 2014 and 13 May 2015;

v. Patient 6 between 18 February 2011 and 23 June 2015;

vi. Patient 9 between 10 April 2012 and 9 March 2015;

b. You did not complete and/ or retain written treatment plans in respect of:

i. Patient 2 on 20 February 2013, 15 August 2013 and/ or 20 September 2014;

ii. Patient 6 on 11 December 2014;

iii. AMENDED TO READ: Patient 7 on 4 January 2011 only in so far as a failure to retain;

iv. Patient 9 on 2 September 2011 and/ or 13 December 2013;

c. You did not adequately record periodontal care and/ or assessments in respect of:

i. Patient 1 between 7 March 2011 and 20 December 2013;

1 Please note that all Schedules are private documents which cannot be disclosed


ii. Patient 6 between 18 February 2011 and 23 June 2015;

iii. Patient 9 on 8 October 2012, 23 April 2013 and/ or 19 March 2015;

d. You did not adequately record and/ or report on radiographs in respect of:

i. Patient 1 on 13 and/ or 27 October 2014;

ii. WITHDRAWN;

iii. Patient 4 on 22 April 2013;

iv. AMENDED TO READ: Patient 6 on 11 December 2014;

e. You did not carry out appropriate radiographic assessments in respect of:

i. Patient 2 between 6 January 2011 and 28 March 2015;

ii. Patient 3 between November 2002 and March 2015;

iii. AMENDED TO READ: Patient 4 between 6 November 2006 and 22 April 2013;

iv. Patient 5 prior to carrying out bridgework on 28 October 2014;

v. Patient 6 between 18 February 2011 and 23 June 2015;

vi. Bitewing radiographs of Patient 7 between 4 January 2011 and 18 April 2015;

vii. Patient 7 following the root filling of UR7 on 19 January 2009;

viii. Patient 9’s UL3 prior to crowning on 4 February 2014;

f. You prescribed antibiotics to:

i. WITHDRAWN;

ii. Patient 7 on 5 November 2013 without sufficient clinical justification;

g. You did not provide smoking cessation advice to Patient 1 between 6 October 2010 and 13 October 2014;

h. Between 18 February 2011 and 18 December 2014 in respect of Patient 6 you did not:

i. Carry out adequate assessments and/or investigations;

ii. Adequately plan treatment;

iii. Provide sufficient information to enable informed consent for the treatment you provided.

4. You failed to maintain an adequate standard of record keeping in that:

a. You did not adequately record discussions regarding treatment planning and/ or the risks and benefits of treatment options in respect of Patient 1 between 6 October 2010 and 13 October 2014;

b. You did not adequately record details of clinical procedures carried out in respect of:

i. Patient 1 between 6 October 2010 and 13 October 2014;

ii. Patient 5 between 28 October 2014 and 6 November 2014;


iii. Patient 7 between 1 November 2013 and 5 November 2013;

c. You did not adequately record the recurrent failure of fillings and/ or discussions of alternative treatment options in respect of Patient 3 between 27 April 2011 and 31 March 2015;

d. You did not adequately record the clinical justification of a fixed bridge in respect of Patient 5 on 28 October 2014;

e. You did not adequately record details of smoking cessation advice in respect of:

i. AMENDED TO READ: Patient 5;

ii. AMENDED TO READ: Patient 6;

f. You did not adequately record the clinical justification for prescribing antibiotics in respect of:

i. Patient 1 on 12 October 2010;

ii. AMENDED TO READ: Patient 6 on 18 February 2011 and 27 March 2013;

iii. Patient 7 on 5 November 2013;

g. You did not adequately record a clinical diagnosis in respect of Patient 6 on 18 February 2011 and/or 27 March 2013;

h. You did not adequately record that post operative care instructions were given following extractions to:

i. AMENDED TO READ: Patient 1 on 06 October 2010 and/ or 26 September 2011;

ii. WITHDRAWN;

iii. Patient 7 on 1 November 2013;

iv. Patient 9 on 23 September 2011, 8 October 2012, 23 April 2013 and/or 16 July 2014;

i. You did not adequately record the notation of the teeth included in partial dentures in respect of Patient 9 on 2 September 2011, 19 October 2012 and/ or 13 December 2013;

j. WITHDRAWN.

Compliance with NHS England and the CQC

5. On 20 April 2016 NHS England carried out an inspection of your practice and identified areas requiring remediation by 28 May 2016.

6. You failed to adequately and/ or at all remediate those areas identified in 5 above by 28 May 2016.

7. At an inspection on 22 June 2016 by the CQC your practice was found to have failed to comply with Regulation 12(1) and/or 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.


Claiming of UDA’s

8. Between on or around 28 March 2014 and 31 March 2015, you caused or permitted claims to be made in your name for Units of Dental Activity (‘UDA’s) under the provisions of the National Health Service as set out in Schedule B.

Claims in higher band than warranted

9. In respect of the following claims you caused or permitted a claim to be made in a higher UDA Band than the treatment provided warranted:

a. 4;

b. 6;

c. 18;

d. 23;

e. 26.

10. In the alternative to 9 above, in respect of the following claims you caused or permitted a claim to be made where no appropriate examination had been provided:

a. 4;

b. 6;

c. 18;

d. 23;

e. 26.

No appropriate examination

11. In respect of the following claims you caused or permitted a claim to be made where no appropriate examination had been provided:

a. 2;

b. 19.

Splitting

12. In respect of the following claims you caused or permitted a claim to be made which split a patient’s treatment, which ought to have formed one single course of treatment and one UDA claim, into separate claims:

a. 2 and 3;

b. 8 and 9;

c. 11 and 12;

d. 15 and 16;

e. 20 and 21;

f. 25 and 26;

g. 27 and 28.


No Treatment Provided

13. In respect of the following claims your caused or permitted a claim to be made for treatment that had not been provided either at all or during the period claimed:

a. 2;

b. 15;

c. 20;

d. 25;

e. 27.

14. Your conduct as set out above at 9, 10, 11, 12 and/ or 13 was:

a. inappropriate;

b. misleading;

c. dishonest in that:

i. you knew it was inappropriate; and/or

ii. it was done with the intention of inflating your UDA claims; and/or

iii. it was done with the intention of preventing a deduction to your payments from the NHS.

And that, by reason of the facts alleged, your fitness to practise is impaired by reason of your misconduct and/ or deficient professional performance.”

On 14 May 2019 the Chairman made the following statement regarding the finding of facts:

“The allegations against Ms Hopkins concern clinical and record keeping matters between 2010 and 2015, an alleged failure to remedy issues identified by the NHS following an inspection of her practice in April 2016, an alleged failure to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as identified by the Care Quality Commission (CQC) at an inspection on 22 June 2016, and alleged inappropriate and dishonest claiming of Units of Dental Activity (“UDA”) from the NHS in 2014/15.

Ms Hopkins chose to attend the hearing only for the purpose of giving oral evidence, as she experienced difficulty in travelling from her home to London. Her attendance at this hearing was a matter for her, and the Committee drew no adverse inference from her absence. She has been represented throughout by Mr Hugh-Jones QC, acting on the instructions of her solicitors, BLM.

The charge contained in the notification of hearing was amended with the agreement of the parties on 11 March 2019, following a joint meeting of two of the experts instructed in this case. The wording of charges 3(b)(iii), 3(d)(iv), 3(e)(iii), 4(e)(i)-(ii), 4(f)(ii), 4(h)(i) was amended and charges 3(d)(ii), 3(f)(i), 4(h)(ii), 4(j) were withdrawn. On the conclusion of the Council’s case on 19 March 2019 the wording of charge 3(b)(iii) was amended and charge 4(j) was withdrawn. This was with the agreement of the parties following the evidence which had been heard.

At the outset of the hearing, Mr Hugh-Jones QC made admissions to the majority of the charges.


The Committee noted the admissions but deferred making any findings of fact until all the evidence had been heard.

The Committee heard evidence from Patients 1 and 7 and from Ms Hopkins.

The witness statements (as redacted) of HT, Dental Case Manager and NHS England South East and of Patient 9 were contained in the agreed bundle.

The Committee heard expert opinion evidence from Mr Alan Canty BDS FDS RCS (Eng.), Mr Julian Scott BDS FFGDP(UK) MPhil, instructed on behalf of the General Dental Council (GDC); and Ms Sharon Caro BDS, instructed on behalf of Ms Hopkins.

The Committee also had regard to 3 testimonials put before it on behalf of Ms Hopkins in support of her character. The Committee took into account those testimonials. However, none of the authors of the testimonials were called to give evidence and the testimonials themselves were in very general terms. The Committee could therefore only attach limited weight to their contents.

The Committee heard the submissions made on behalf of the GDC by Miss Barnfather and those made by Mr Hugh-Jones. Mr Hugh-Jones provided a written closing skeleton argument and confined his submission to the question of dishonesty, stating that the contested clinical matters were now “narrowed and the Committee will be well versed in dealing with the balance”.

The Committee accepted the advice of the Legal Adviser. The burden is on the GDC to prove each allegation on the balance of probabilities.

Findings

The Committee found both Patients 1 and 7 to be credible witnesses. They answered the questions put to them honestly and to the best of their recollection, making clear when they could not remember. It was apparent that their only motive was to assist the Committee with its inquiry.

The Committee was greatly assisted by each expert and the joint report:

(a) Mr Canty was straightforward in his evidence and readily conceded points during his oral evidence, showing an open mind and objective self-reflection on the opinion he had given.

(b) Mr Scott knew the system of NHS claiming in great depth. He was a most experienced and authoritative expert in this field. His report was comprehensive and was produced with meticulous care and attention to detail. He gave his opinion neutrally and impartially to assist the Committee in its decision making.

(c) Ms Caro was also credible and gave her opinion from a neutral and objective perspective.

There was limited dispute between the experts at this stage of the proceedings.

The Committee found Ms Hopkins to be an unreliable and inconsistent witness, whose oral evidence contradicted much of her witness statement and indeed she also contradicted herself at different stages of her oral evidence.

I will now announce the Committee’s findings in relation to each head of charge:

1. In the period subject to the allegations below you were practising in general dentistry as the owner of [redacted]

Admitted and found proved.

2. You provided care and treatment to the patients set out in Schedule A.



Inadequate care/ record keeping

3. You failed to provide an adequate standard of care in that:

3.(a) You did not adequately update the current medical history in respect of:

3.(a)(i) Patient 2 between 6 January 2011 and 28 March 2015;

Proved.

Ms Hopkins admitted this charge only in so far as it related to a failure to record the medical history update. Her evidence was originally that she always updated the medical history, as stated in her witness statement:

18. It was, and still remains, my routine practice to ask patients to complete and sign a medical history form every year. I would, however, seek to take an oral medical history update at every other appointment. This would include whether there was any update or new history. I would also ask patients about any medication that they taking prior to providing any treatment, if they had any allergies before prescribing antibiotics and whether they were taking any blood thinners prior to an extraction.

However, Ms Hopkins changed her account when giving oral evidence. For example, when cross examined she stated:

Q. Now, you said, and you again repeat this, you would not check the medical history at examination, so not when they are coming back for their six-monthly check-up or their two-monthly check up, is that right? But you would ask them specific questions before a procedure?

A. Mmm.

Q. You said in your evidence “I don’t bring it up on a check-up as it’s not relevant.”

A. Well, no, it’s not - well, I've never ever found that it - you know, I need to ask a patient again about their medical history. Most patients, if their medical history has changed and they’ve gone on to new medication, they will immediately tell me.

Q. Yes, but, Miss Hopkins, that is relying on the patient to volunteer information, the patient not necessarily appreciating the significance of their medication in terms of their dental treatment. Do you follow me?

A. Yes.

Q. I suggest, Miss Hopkins, it is clear from your records and indeed from your evidence that your practise in respect of medical histories was very variable, wasn’t it?

A. Well, yes, I admit that. It’s not now, but it was then.

Q. Indeed since, no doubt, you have perhaps made efforts to rectify that ---

A. I have.

Q. --- but at this time it was somewhat haphazard, wasn’t it?

A. Yeah, I admit that.

Q. It, in effect, was left to chance as to whether the questionnaire was updated regularly or not?

A. Yeah, probably you're right there.

Q. It was also left to chance as to whether you elicited it from the patient? I mean


there might be a patient who has come back, come back for a check-up in the interim, they have been put on medication, you do not ask at the check-up or the examination, do you?

A. Well, no, I didn’t used to ask at the check-up because I wasn’t going to do anything that really I needed to know about, any new medication.

And when answering a question from a member of the Committee:

Q: …when you say “check the medical history before treatment” do you mean you check the notes or do you actually verbally ask the patient when they come to you?

A. No, I will get the medical history out, the notes, so that I can go through the medical history.

Q. So do you talk to the patient?

A. I talk to the patient, yes, if there is anything on it that I think I ought to talk to them about.

Q. If it just said “Medical history clear”, so if you have a patient in the surgery, you sat them down and you were going to do treatment and then you get out the medical history ---

A. I look at it. I want to see that there is no reason.

Q. If it is clear what happens, do you speak to the patient or not about it?

A. No, I don’t think so if it is all clear and okay so I can carry on with the treatment. I only speak to them if there is an issue on the medical history that I just want clarifying.

The Committee could find no evidence in the records of a medical history update in respect of each of the patients and occasions pleaded under charges 3(a)(i)-(vi).

The Committee was satisfied from the records and from Ms Hopkins’ own oral evidence that no medical history updates were taken on the occasions alleged.

3.(a)(ii) Patient 3 between 1 May 2012 and 31 May 2015;

Proved.

3.(a)(iii) Patient 4 between 3 February 2011 and 5 August 2014;

Proved.

3.(a)(iv) Patient 5 between 3 June 2014 and 13 May 2015;

Proved.

3.(a)(v) Patient 6 between 18 February 2011 and 23 June 2015;

Proved.

3.(a)(vi) Patient 9 between 10 April 2012 and 9 March 2015;

Proved.

3.(b) You did not complete and/ or retain written treatment plans in respect of:


3.(b)(i) Patient 2 on 20 February 2013, 15 August 2013 and/ or 20 September 2014; Admitted and found proved (only in so far as a failure to retain).

In respect of charges 3(b)(i)-(iv), the admissions go only to a failure to retain the written treatment plans. It was Ms Hopkins’ evidence that she would have completed the treatment plan on the FP17DC form but that these documents appear to have been lost from the practice records for reasons which she cannot explain.

In respect of charge 3(b)(ii) it was no longer alleged by the Council that Ms Hopkins had failed to complete the written treatment plan, only that (as she admits) there had been a failure to retain.

The Committee finds the charges proved only in relation to a failure to retain. There is evidence before the Committee of FP17DCs being completed by Ms Hopkins in respect of other treatment, which suggests that (consistent with her evidence) her practice was to complete a written treatment plan. There was evidence that form FP17DCs had been filed separately from patient records in the past and the possibility of those forms being mislaid was thus accepted. Therefore, the Committee considered there was insufficient evidence to disprove that she did not complete a written treatment plan on the occasions alleged under charge 3(b). The GDC has not discharged its burden of proof in that regard.

3.(b)(ii) Patient 6 on 11 December 2014;

Admitted and found proved (only in so far as a failure to retain).

3.(b)(iii) AMENDED TO READ: Patient 7 on 4 January 2011 only insofar as a failure to retain;


3.(b)(iv) Patient 9 on 2 September 2011 and/ or 13 December 2013;

Admitted and found proved (only in so far as a failure to retain).

3.(c) You did not adequately record periodontal care and/ or assessments in respect of:

3.(c)(i) Patient 1 between 7 March 2011 and 20 December 2013;


3.(c)(ii) AMENDED TO READ: Patient 6 between 18 February 2011 and 13 July 2013;


3.(c)(iii) Patient 9 on 8 October 2012, 23 April 2013 and/ or 19 March 2015;

Admitted (save for 19 March 2015) and found proved in its entirety.

Ms Hopkins did not admit this charge in relation to the 19 March 2015. The Committee found the allegation proved in its entirety. In respect of the 19 March 2015 appointment, the Committee took into account a laboratory docket for a repair with the notation of missing teeth on the denture, and the dental charting recorded on the patient’s record. The Basic Periodontal Examination (BPE) was clearly inaccurate due to the missing teeth.

3.(d) You did not adequately record and/ or report on radiographs in respect of:


3.(d)(i) Patient 1 on 13 and/ or 27 October 2014;


3.(d)(ii) WITHDRAWN

3.(d)(iii) Patient 4 on 22 April 2013;


3.(d)(iv) AMENDED TO READ: Patient 6 on 11 December 2014;


3.(e) You did not carry out appropriate radiographic assessments in respect of:

3.(e)(i) Patient 2 between 6 January 2011 and 28 March 2015;


3.(e)(ii) Patient 3 between November 2002 and March 2015;

Admitted and found proved

3.(e)(iii) AMENDED TO READ: Patient 4 between 6 November 2006 and 22 April 2013;


3.(e)(iv) Patient 5 prior to carrying out bridgework on 28 October 2014;

Proved.

Although not formally admitted by Ms Hopkins, this allegation was accepted by her during cross examination:

Q. In fact, in the claims this is one we are referring to as claim 19. There is no record, is there, of an x-ray being taken prior to the provision of the bridge, even before designing a bridge?

A. No, it doesn’t seem so.

Q. There is no report of one?

A. No.

Q. No?

A. Because I didn’t take one.

Q. There is no discussing with the patient obviously because you did not take one?

A. No, I probably – I probably assessed it as being ---

Q. Suitable visually?

A. --- suitable visually to do a crown on.

Q. We will come back to that, but I think again, in fairness to you, this is something you said in your evidence yesterday ---

A. Did I?

Q. --- I think you said “I probably should have x-rayed it ...”

A. I should.

Having regard to the expert opinion and Ms Hopkins’ acceptance of the allegation


during her oral evidence, the Committee found the charge proved.

3.(e)(v) Patient 6 between 18 February 2011 and 23 June 2015


3.(e)(vi) Bitewing radiographs of Patient 7 between 4 January 2011 and 18 April 2015;


3.(e)(vii) Patient 7 following the root filling of UR7 on 19 January 2009;

Not proved.

The entry in the clinical records for 19 January 2009 states “as per protocol”. In light of this entry and Ms Hopkins’ own evidence regarding a protocol for root canal treatment which included radiographic assessment as one of the stages of the treatment, the Committee concluded that the GDC has not discharged its burden of proving that Ms Hopkins had failed to carry out an appropriate radiographic assessment.

3.(e)(viii) Patient 9’s UL3 prior to crowning on 4 February 2014;


3.(f) You prescribed antibiotics to:

3.(f)(i) WITHDRAWN

3.(f)(ii) Patient 7 on 5 November 2013 without sufficient clinical justification;

Proved.

There is nothing in the notes recording a clinical justification nor could Ms Hopkins demonstrate that she had any clinical justification when she was cross examined:

Q …but can you explain to the Committee again what was your justification for the antibiotic prescription?

A. If the patient had an obviously infected socket and had a swollen gum and a complaint that said – they obviously had an infection and they were complaining of pain, he might have had a swollen face even, but it’s quite obvious to me it was an infected socket and so I would give antibiotics in that instance.

Q. Can you remember this?

A. No, why would I?

3.(g) You did not provide smoking cessation advice to Patient 1 between 6 October 2010 and 13 October 2014;

Proved.

Patient 1 was a life-long heavy smoker at the time. His evidence was that he did not receive smoking cessation advice from Ms Hopkins. Ms Hopkins stated in her oral evidence that she does not usually give smoking cessation advice to patients, suggesting that such advice was often not welcome to smokers. She illustrated this by giving an example of one of her patients who told her he would commit suicide if he had to stop smoking.

On the evidence, the Committee found that as a matter of fact Ms Hopkins did not


give smoking cessation advice to Patient 1.

The Committee had regard to the Department of Health guidance sent to all practices a long ago as 2009. The guidance requires dental practitioners to give smoking cessation advice to their patients as a mater of public health. The Committee was satisfied that Ms Hopkins was therefore under a duty to give smoking cessation advice to her patient. Accordingly, the Committee found this charge proved.

3.(h) Between 18 February 2011 and 18 December 2014 in respect of Patient 6 you did not:

3.(h)(i) Carry out adequate assessments and/or investigations;


3.(h)(ii) Adequately plan treatment;


3.(h)(iii) Provide sufficient information to enable informed consent for the treatment you provided

Proved.

Ms Hopkins failed to carry out an adequate assessment of the patient and failed to adequately plan the treatment. She could not therefore have provided sufficient information to enable to the patient to give their informed consent.

4. You failed to maintain an adequate standard of record keeping in that:

4.(a) You did not adequately record discussions regarding treatment planning and/ or the risks and benefits of treatment options in respect of Patient 1 between 6 October 2010 and 13 October 2014;


4.(b) You did not adequately record details of clinical procedures carried out in respect of:

4.(b)(i) Patient 1 between 6 October 2010 and 13 October 2014;


4.(b)(ii) Patient 5 between 28 October 2014 and 6 November 2014;


4.(b)(iii) Patient 7 between 1 November 2013 and 5 November 2013;


4.(c) You did not adequately record the recurrent failure of fillings and/ or discussions of alternative treatment options in respect of Patient 3 between 27 April 2011 and 31 March 2015;


4.(d) You did not adequately record the clinical justification of a fixed bridge in respect of Patient 5 on 28 October 2014;



4.(e) You did not adequately record details of smoking cessation advice in respect of:

4.(e)(i) AMENDED TO READ: Patient 5;


4.(e)(ii) AMENDED TO READ: Patient 6;


4.(f) You did not adequately record the clinical justification for prescribing antibiotics in respect of:

4.(f)(i) Patient 1 on 12 October 2010;


4.(f)(ii) AMENDED TO READ: Patient 6 on 18 February 2011 and 27 March 2013;


4.(f)(iii) Patient 7 on 5 November 2013;


4.(g) You did not adequately record a clinical diagnosis in respect of Patient 6 on 18 February 2011 and/or 27 March 2013;


4.(h) You did not adequately record that post operative care instructions were given following extractions to:

4.(h)(i) AMENDED TO READ: Patient 1 on 06 October 2010 and/ or 26 September 2011;


4.(h)(ii) WITHDRAWN

4.(h)(iii) Patient 7 on 1 November 2013;


4.(h)(iv) Patient 9 on 23 September 2011, 8 October 2012, 23 April 2013 and/or 16 July 2014;


4.(i) You did not adequately record the notation of the teeth included in partial dentures in respect of Patient 9 on 2 September 2011, 19 October 2012 and/ or 13 December 2013;


4.(j) WITHDRAWN

Compliance with NHS England and the CQC

5. On 20 April 2016 NHS England carried out an inspection of your practice and identified areas requiring remediation by 28 May 2016.



6. You failed to adequately and/ or at all remediate those areas identified in 5 above by 28 May 2016.


7. At an inspection on 22 June 2016 by the CQC your practice was found to have failed to comply with Regulation 12(1) and/or 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.


Claiming of UDA’s

8. Between on or around 28 March 2014 and 31 March 2015, you caused or permitted claims to be made in your name for Units of Dental Activity (‘UDA’s) under the provisions of the National Health Service as set out in Schedule B.


Claims in higher band than warranted

9. In respect of the following claims you caused or permitted a claim to be made in a higher UDA Band than the treatment provided warranted:

9.(a) 4;


9.(b) 6;


9.(c) 18;


9.(d) 23;


9.(e) 26;


10. In the alternative to 9 above, in respect of the following claims you caused or permitted a claim to be made where no appropriate examination had been provided:

10.(a) 4;

10.(b) 6;

10.(c) 18;

10.(d) 23;

10.(e) 26;

Charges 10(a)-(e) not considered in the light of the findings made under the alternative charge 9.


No appropriate examination

11. In respect of the following claims you caused or permitted a claim to be made where no appropriate examination had been provided:

11.(a) 2;


11.(b) 19.


Splitting

12. In respect of the following claims you caused or permitted a claim to be made which split a patient’s treatment, which ought to have formed one single course of treatment and one UDA claim, into separate claims:

12.(a) 2 and 3;


12.(b) 8 and 9;

Proved.

The courses of treatment concerned the placement of 5 fillings over 2 appointments on 28 April 2014 and 12 May 2014.

Claim 8 related to the appointment on 28 April 2014 when 2 fillings were place. Ms Hopkins recorded that the treatment was complete, marked the patient for a review appointment in October 2014 and claimed a band 2 course of treatment from the NHS, declaring that all necessary treatment had been provided.

However, the patient (Patient 3) was booked in for another appointment a week later on 6 May 2015. That appointment was subsequently rescheduled by the Practice for 12 May 2014, when a further 3 fillings were placed and second band 2 claim submitted. There is no evidence to suggest that the appointment was an emergency appointment and it is inherently unlikely that Ms Hopkins could have failed to detect on 28 April 2014 that the patient would need a further 3 fillings in addition to the 2 she was placing that day. The forms were marked so that the patient would not themselves be paying any fee in respect of the second set of fillings, thus avoiding the arousal of suspicion from the patient. Further, Ms Hopkins retrospectively amended the records to record that only 1 filling had been provided on 12 May 2014. The Committee was satisfied that the likely reason for this was to conceal the fact that she had split the treatment, as the placement of 1 filling so soon after the completed course of treatment in April would arouse less suspicion than the 3 further fillings which were in fact placed.

12.(c) 11 and 12;

Proved.

As with claims 8 and 9 Ms Hopkins claimed for two band 2 courses of treatment in respect of two appointments a week apart. One filling was placed at the first appointment and another filling was placed at the second. The forms were marked so that the patient would not pay a second fee for the second filling, thus avoiding


the arousal of suspicion from the patient.

12.(d) 15 and 16;

Proved.

No treatment was provided in respect of the first course of treatment claimed for by Ms Hopkins (claim 15), which related to an appointment on 29 July 2014. As stated by Ms Hopkins when cross examined:

Q. Now for that first appointment on the 29 July there was no treatment recorded. There was an examination, a full mouth examination, a BPE and a soft tissue but there wasn’t any actual treatment provided, was there?

A. No, I don’t think so. I don’t know.

Q. So why ---

A. That was a mistake. I have already admitted that.

Q. Another mistake?

A. Yes.

Q. Another mistake in your UDA favour because you have claimed three UDAs for this?

A. Yes, but it is a mistake. I make mistakes, I am afraid.

12.(e) 20 and 21;


12.(f) 25 and 26;


12.(g) 27 and 28;


No Treatment Provided

13. In respect of the following claims your caused or permitted a claim to be made for treatment that had not been provided either at all or during the period claimed:

13.(a) 2;


13.(b) 15;

Proved.

As per the Committee’s findings at 12(d) above, no treatment was provided in respect of this claim number.

13.(c) 20;


13.(d) 25;



13.(e) 27.


14. Your conduct as set out above at 9, 10, 11, 12 and/ or 13 was:

14.(a) inappropriate; Admitted and found proved.

14.(b) misleading;


14.(c) dishonest in that:

14.(c)(i) you knew it was inappropriate; and/or

Proved.

14.(c)(ii) it was done with the intention of inflating your UDA claims; and/or

Proved.

14.(c)(iii) it was done with the intention of preventing a deduction to your payments from the NHS.

Proved. The Committee considered each sub-charge in 14(c) separately but provides its reasons collectively below.

Ms Hopkins has practised as a dentist for over 40 years. She has no adverse regulatory history and the Committee has taken that into account as well as the testimonials to which reference has already been made. She is an intelligent professional who owns her own practice and was a contract holder with the NHS at the time of these events. In respect of each of the claims she submitted she signed a declaration stating that the information given on the claim form was correct and complete. When her claiming was under investigation she made retrospective amendments to the records in order to give the impression that her claiming was legitimate. It was only because the GDC already had copies of the original patient records that the retrospective amendments were detected. The Committee found Ms Hopkins to be wholly unreliable and inconsistent in her evidence.

The Committee found on the balance of probability that Ms Hopkins knew her claiming was inappropriate. It is not in dispute that her claiming was in fact inappropriate and misleading. She admits to that (except in relation to charges 10(b) and 12(b)-(d)). Her defence is that she did not understand her claiming to be inappropriate at the time. Whilst there is clear evidence of extraordinary carelessness and chaos in her practice, all of her inappropriate claims worked in her favour and involved the retrospective amendment of records and the marking of records in a way which meant that a patient would not be charged twice for what would in the patient’s perception be the same course of treatment. There was evidence of entries made in the patient records for treatment that had not taken place on particular days in order to support UDA claims. If her inappropriate and misleading claims were genuinely the result of ignorance or carelessness then the Committee would expect to see evidence of underclaiming in addition to overclaiming but there is no such evidence. The year 2014/15 (to which the


inappropriate claims relate) was a year in which Ms Hopkins avoided a clawback from the NHS. In the earlier years to which reference was made in the evidence a clawback had been applied because her practice had not fulfilled its contractual requirement in respect of UDA delivery. Ms Hopkins sought to explain her improved performance in the year 2014/15 by reference to what she said was her improved state of health in that year. However, the Committee was not satisfied that this explained the significant uplift in UDA performance to the year end and the variety of unjustified claims evident in the clinical records.

The Committee was satisfied that Ms Hopkins made inappropriate entries to inflate her UDA claims and to avoid a deduction to her payments from the NHS.

Mr Hugh-Jones argued that the sample of 9 patients was neither random nor sufficient to represent Ms Hopkins’ practice. Mr Scott addressed this point in cross examination. He accepted that the records he had reviewed were not a random sample. However, his view was that the records did give a good indication of what was happening with the data. In any event however, having heard Ms Hopkins’ evidence and reviewed the clinical records with the assistance of Mr Scott, the Committee rejected her explanation for the way in which these claims relating to UDAs had been made. The Committee was satisfied that the claims in question were made dishonestly for the reasons set out in the charge.

We move to Stage Two.”

On 14 May 2019 the Chairman announced the determination as follows:

“Ms Hopkins,

The Committee announced its findings of fact on 5 April 2019 and resumed at Stage of 2 of its procedure on 13 May 2019.

The facts

You qualified in 1976. In 1988 you purchased the Southway’s Surgery, East Sussex (the “Practice”) from where you have practised ever since as the principal dentist. You no longer practise NHS dentistry.

On 20 April 2016 NHS England carried out an inspection of your Practice. You completed a self-assessment form in advance of the inspection. On 28 April 2016 NHS England wrote to you regarding the inspection: “Following the submission of the self-assessment checklist the team did not expect to find so many outstanding issues; it is noted that in some cases incorrect information was entered…”. The letter then listed some 57 wide ranging matters requiring attention, including matters relating to radiography, cross infection control, decontamination and clinical waste disposal.

NHS England required some of the matters to be addressed “immediately” with timescales provided for the remaining matters to be addressed.

You wrote to NHS England by letter dated 21 May 2016 in respect of attending required courses, stating:


…Attending a course would be stressful for me and outside my comfort zone [in relation to stated physical health conditions]. In light of this I do not feel able to attend any courses. I am able to do the learning at the surgery where I am comfortable.

In view of this I would ask to be exempted from courses which require my attendance outside my comfort zone…

On 22 June 2016 the Care Quality Commission (CQC) visited your Practice. By letter dated 25 July 2016 they proposed to cancel your CQC registration in light of concerns which they had identified as breaching Regulations 12(1) and 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In respect of Regulation 12(1), “safe care and treatment”, the CQC reported the following issues to you by letter dated 25 July 2016:

3, You have failed to ensure dental instruments were protected against the possibility of recontamination because we saw unwrapped instruments were stored on open trays beside the sink used for the manual scrubbing of dirty instruments in surgery one…

4, We witnessed the dentist take unwrapped instruments from the storage trolley drawers during a patients [sic] treatment without changing gloves which had been in the patients [sic] mouth… the dentist in question… confirmed that this was their normal daily practice.

5, You have failed to provide a barrier when storing re-processed instruments to ensure that they are not recontaminated as we saw instruments intended for use on patients were stored alongside a used hair comb, used toothbrush, paperwork, pens and debris. The condition of the drawers appeared dirty and disorganised.

6. You have failed to maintain the ultrasonic baths used in the decontamination process in line with HTM 1-05 to ensure that they were working… the build up of debris will reduce the effectiveness of cleaning… The contents of both baths were checked at the time the surgery opened and were found to be cloudy and contained debris and appeared dirty although the surgery start up sheet had indicated that the water had been changed that day. Staff were confused about what they needed to do to make sure that both ultrasonic baths were working effectively and were of a suitable state of cleanliness… 7, You have failed to ensure the safety of patients by the use of materials that had passed their expiry date. We found a number of expired materials including Endomethansone. (Endomethansone which was used when completing a root canal filling was withdrawn from use in 2010 due to the identification of this substance as being potentially hazardous to health). Traces of Endomethasone were present on some of the instruments used during root canal fillings. There instruments were stored in a cube of foam which appeared grubby. These items are designed for single use only however as these had been retained and stored in an area with other dental instruments they then appeared available for use. Other expired materials included, prime and bond… which had expired in 2008…

8, You have failed to protect patients and staff from the spread of infection by the re-use of equipment marked as single use only. Single use items such as prophy cups and brushes (instruments used when polishing teeth), perio probes (used to assist with diagnosing gum disease) and suction tubes were placed in a cold bath on the worktop. The bath contained cold water, no detergent or other cleaning agent and the water was dirty with collections of debris at the bottom. Staff confirmed that these single use items had been put into the bath to re-use. We saw dirty, contaminated prophy brushes in a stand which staff confirmed and we saw were used during a patient’s treatment. All of the brushes contained old paste. (Cold water baths have not been recommended for use for several years.)

9, You have failed to arrange a dirty to clean flow zoning within the decontamination area. This flow is essential to ensure that dirty instruments do not contaminate clean instruments. The


decontamination area was in the kitchen and instruments were left to dry next to tea and coffee making facilities. Also, we witnessed staff eating their food in this area.

10, You have failed to protect patients and staff from the spread of infection due to the way that used, contaminated instruments and clean instruments were carried throughout the practice on open trays…

11, You have failed to protect staff and patients from the risks of the spread of infection and injury. Three dogs were situated under the reception desk. Staff told us they do not enter the clinical area. Two of the dogs were aggressive and staff told us that they do not like people. One of the dogs bit the inspector’s leg…

12, …You have failed to provide appropriate hand washing facilities. The hand washing sink in surgery one was inaccessible as there were other freestanding objects stored in front of it. When staff were asked where they washed their hands whilst working in this surgery they indicated they used the inaccessible sink. The sink was dry following the morning session and there were no soap or paper towels to facilitate good hand washing practices…

13, You have failed to maintain equipment used in the provision of services to sufficient working and hygiene standards. The practice used mobile suction units with a removable bottle. This suction unit is used during dental treatment to remove fluid and debris from the patients [sic] mouth including saliva, blood and filling material. Staff told us the contents of the suction unit bottle had until recently been disposed of in the sink used to scrub instruments. The mobile unit in surgery 2 was missing a door to cover the internal components and had a large wedge of foam underneath it to stop it from moving…

14, You have failed to maintain your dental unit water lines to prevent the spread of infection…

15, You have failed to adhere to the Hazardous Waste (England and Wales) Regulations 2005 with regard to human tissue and mercury disposal…

16, You have failed to reduce the risk of inhalation and or ingestion of small instruments and materials used in the provision of root canal treatment… Although the practice had a rubber dam kit and staff assured us that it was used routinely, there were few clamps and no rubber sheets meaning that it was incomplete and not fit for use…

In respect of Regulation 17(1), “Good Governance”, the CQC reported failures to undertake audits and assessments of contamination and infection control measures and failures to establish a safe radiography practice by means of quality assurance audits to ensure that patients are not being overexposed to radiation.

The CQC also reported, under the heading “Relevant History of Non-Compliance”:

In addition to the evidence cited above, we also took account of your history of non-compliance. In particular, NHS [England] inspected the Dental Practice on 20 April 2016. Following this inspection, a report was issued identifying failures to comply with Regulations 12(1) and 17(1). A report detailing the required improvements was issued dated 28 April.

On our inspection we found a number of areas that had not been addressed with regard to the correct disposal of extracted teeth, the wilful re-use of single use items and failure to safely store instruments. Therefore, you failed to achieve compliance by the specified end date. This is evidence of a history of failing to respond adequately to serious concerns raised by NHS [England].

The Practice was ultimately voluntarily closed for a period of 2 months whilst you undertook the necessary remedial work. When the Practice was re-inspected on 4 October 2016 there were still areas of concern. Concerns were also reported to the General Dental Council (GDC) from which there followed a fitness to practise investigation which has culminated in this hearing. As part of its investigation the GDC reviewed the records of Patients 1-9, whose records had previously been reviewed by NHS England in 2016. So far as is relevant to the matters which have reached the


Committee, clinical and record keeping failings (including failures to record and report on radiographs) were identified in your care and treatment of Patients 1-7 and 9 between 2011 and 2015 and probity concerns were identified in respect of the claims for Units of Dental Activity (UDAs) which you had made for Patients 1-9 for the financial year 2014/15.

Using a variety of methods, you dishonestly overclaimed the number of UDAs to which you were entitled in respect of each course of treatment, including by splitting claims and by claiming for treatment not provided. In response to the GDC investigation you retrospectively amended a number of the patient records in an attempt to conceal your dishonest claiming, seemingly unaware that copies the original patient records had already been provided to the GDC by the NHS.

Submissions

Miss Barnfather, for the GDC, submitted that your fitness to practise is currently impaired by reason of misconduct and that the only proportionate sanction is that of erasure. She submitted that your failings, including your clinical failings, are attitudinal in nature and are therefore very difficult to remedy. She submitted that you are incapable of remediation because you cannot or will not accept where fault lies. With regard to your dishonest claiming you had a moral compass set at self-interest before public interest. The absence of any reflection by you in the remediation bundle on your dishonesty is notable. You have put patients at unwarranted risk of harm, you have brought the dental profession into dispute and you have breached a fundamental tenet of the profession.

Mr Hugh-Jones QC, on your behalf, referred to the level of remediation you have undertaken in respect of the clinical matters. As to your dishonesty, he referred to Rules 20 and 21 of the General Dental Council (Fitness to Practise) Rules 2006, submitting that the Committee must limit its consideration to the 9 patients referred to in the proven charges (“in the light of the facts found”) and must disregard any wider statistical data of potential inappropriate claiming.

Mr Hugh-Jones QC conceded that the Committee are likely to find current impairment by virtue of the findings in respect of dishonesty. He then confined his submissions on the question of sanction to suspension (as opposed to erasure), submitting that a period of suspension for 12 months would be sufficient to maintain the public interest in the circumstances of this case. He referred the Committee to the following factors: you have contributed some 40 years to the NHS in your practice as a dentist; there is some defence testimonial evidence that your dishonesty was out of character; there were no adverse findings against you prior to these proceedings and you have now lost your good character; there has been 3 years or so of compliance with regulations and a progress towards remediation with you showing a striking commitment to dentistry and to turning your practice around; the subsequent CQC report in October 2016 was only partially adverse and the CQC did not consider it necessary to visit your Practice after October 2016; the offences in this case span 2014-15, some 4 ¼ years ago; you are now in your seventies and erasure would effectively end your career.

Decision

The Committee accepted the advice of the Legal Adviser. The Committee had regard to the Guidance for the Practice Committees, including Indicative Sanctions Guidance (October 2016).

Misconduct

Misconduct is a serious departure from the standards reasonably expected of a dental professional. The Committee had regard in particular to the following principles from Standards for Dental Professionals (2005-2013):


1.1 Put patients’ interests before your own or those of any colleague, organisation or business.

1.2 Follow these principles when handling questions and complaints from patients and in all other of nonclinical professional service.

1.3 Work within your knowledge, professional competence and physical abilities. Refer patients for a second opinion and for further advice when it is necessary, or if the patient asks. Refer patients for further treatment when it is necessary to do so.

1.4 Make and keep accurate and complete patient records, including a medical history, at the time you treat them. Make sure that patients have easy access to their records.

2.2 Recognise and promote patients’ responsibility for making decisions about their bodies, their priorities and their care, making sure you do not take any steps without patients’

consent (permission). Follow our guidance ‘Principles of patient consent’.

2.4 Listen to patients and give them the information they need, in a way they can use, so that they can make decisions. This will include:

- communicating effectively with patients; - explaining options (including risks and benefits); and - giving full information on proposed treatment and possible costs.

5.1 Recognise that your qualification for registration was the first stage in your professional education. Develop and update your knowledge and skills throughout your working life.

5.2 Continuously review your knowledge, skills and professional performance. Reflect on them, and identify and understand your limits as well as your strengths.

5.3 Find out about current best practice in the fields in which you work. Provide a good standard of care based on available up-to-date evidence and reliable guidance.

5.4 Find out about laws and regulations which affect your work, premises, equipment and business, and follow them.

And from Standards for the Dental Team (2013):

1.1.1 You must discuss treatment options with patients and listen carefully to what they say. Give them the opportunity to have a discussion and to ask questions.

1.3 You must be honest and act with integrity

1.3.1 You must justify the trust that patients, the public and your colleagues place in you by always acting honestly and fairly in your dealings with them. This applies to any business or education activities in which you are involved as well as to your professional dealings.

1.3.2 You must make sure you do not bring the profession into disrepute.

1.4.2 You must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situation.

You may need to balance their oral health needs with their desired outcomes.

If their desired outcome is not achievable or is not in the best interests of their oral health, you must explain the risks, benefits and likely outcomes to help them to make a decision.

1.5.1 You must find out about the laws and regulations which apply to your clinical practice, your premises and your obligations as an employer and you must follow them at all times. This will include (but is not limited to) legislation relating to:

• the disposal of clinical and other hazardous waste

• radiography


• health and safety

• decontamination

• medical devices.

(Further information on laws and regulations can be found on our website. Your professional association or defence organisation can also help you to find out which laws and regulations apply to your work.)

1.7.1 You must always put your patients’ interests before any financial, personal or other gain.

1.9 You must find out about laws and regulations that affect your work and follow them

2.1 Communicate effectively with patients – listen to them, give them time to consider information and take their individual views and communication needs into account.

3.1 Obtain valid consent before starting treatment, explaining all the relevant options and the possible costs.

3.2 Make sure that patients (or their representatives) understand the decisions they are being asked to make.

4.1 Make and keep contemporaneous, complete and accurate patient records.

7.1 Provide good quality care based on current evidence and authoritative guidance.

9.1 Ensure that your conduct, both at work and in your personal life, justifies patients’ trust in you and the public’s trust in the dental profession.

The Committee grouped its findings of fact into three categories: (i) the clinical and record keeping failings (charges 3 and 4); (ii) the NHS and CQC inspection failings (charges 5 to 7); (iii) the dishonest overclaiming of UDAs from the NHS (charges 8 to 14).

In the Committee’s judgment there is a clear case of misconduct in each category. There have been substantial and repeated breaches of all the above standards. The clinical and record keeping failings were most basic and were sustained over a long period. The NHS and CQC inspection failings demonstrated largely attitudinal failings in complying with most basic regulatory and public health standards and demonstrated a real risk of harm to patients in respect of cross infection control. Your dishonesty involved fraud against the NHS and the abuse of the trust placed in you by Patients 1-9, in respect of whom you made the inappropriate claims.

The Committee finds that the facts found proved in each category amount to misconduct. The question of deficient professional performance therefore fell away (the same facts cannot amount to both misconduct and deficient professional performance). Miss Barnfather also confirmed to the Committee that the GDC pursued its case on the statutory ground of misconduct only.

Impairment

The Committee next considered whether your misconduct is remediable, whether it had been remedied and the risk of repetition. The Committee also had regard to the wider public interest, which includes the need to declare and uphold proper standards of conduct and behaviour.

Clinical failings are in principle remediable through learning, reflection and embedded

improvement in practice. The Committee was not satisfied in this case that your clinical failings have been remedied, owing to what appear to be substantial attitudinal failings on your part. The Committee was provided with evidence of Continuing Professional Development (CPD) learning completed but saw little evidence that this was embedded into your practice. For example, much of your CPD activity on cross infection control and decontamination predated the July 2016 CQC inspection and yet that learning had not been embedded in your practice, given the extent of the


deficiencies identified from the inspection. In the Committee’s judgment, the standards of hygiene and cross infection control at your practice were deplorable.

You also stated that you had not undertaken any training in Ionising Radiation (Medical Exposure) Regulations 2000 (IRMER) as you had learned the basics as an undergraduate in the 1970’s and considered that not a lot had changed since then. In your written reflection on a course you then completed on 16 September 2016, you stated:

I was taught Ionising Radiation By Professor Joseph Rotblat at St. Bartholomew's Hospital

and although it was a long time ago I have not forgotten my earlier learning. Joseph Rotblat

was the founder father of ionising radiation and a world renowned Nuclear Physicist. He

always impressed the dangers of radiation on his students and he was an imposing man.

Not one to be forgotten. I was always aware of the dangers of radiation and have always

practised with a mind to keeping all Xraying to a minimum. [sic]

The Committee was provided with further evidence of CPD learning since 2016 but once again saw little evidence that this was embedded into your practice.

You lack understanding of why improvements in your practice are really needed, describing the NHS and CQC inspections as identifying “nit picky things” and suggesting that some of the resulting improvements you eventually made to your practice were counter-productive.

With the exception of one course, all of the CPD activity you put before the Committee from May 2013 to present consisted only of online activities. This, in the Committee’s judgment, is a reflection of your attitude and your professional isolation, where you do not engage with any community of dentists as part of your professional development and learning.

Whilst Personal Development Plans (PDP) for previous years had been submitted there was no current PDP to outline future learning before the Committee. No good reason was provided for the absence from the remediation bundle of such a relevant document to your remediation. There were also no reflective logs for the last 2 years before the Committee.

The Committee concluded that you show only limited insight into your clinical and record keeping failings, and into your NHS and CQC inspection failings. You have not remedied these matters and your lack of remediation is attitudinal. There is therefore a continuing risk of harm to the public should you be allowed to practise without restriction. As to your dishonesty, you show a lack of remorse or reflection. The Committee noted that you denied the allegations of dishonesty, stating your inappropriate claiming to be merely the result of error or a lack of understanding of the NHS regulations.

The Committee had regard to the positive reports from your workplace supervisor in respect of your interim conditions. His most recent report dated 30 April 2019 stated:

Aileen’s progress is incredible. It is very clear that she has a sound knowledge base and sound clinical abilities. She has always made reference to limitations and gaps in her regulatory knowledge, but this has now been brought up to a good standard. We are now at a point in our series of tutorials struggling to find topics which will test Aileen’s abilities.

Whilst the Committee respects the opinion of the workplace supervisor and is reassured by his reports, which go only to the clinical failings, the Committee having heard evidence from you at Stage 1 of these proceedings over 2 days was not satisfied that the reports are a full reflection of your remediation and progress.


Accordingly, the Committee finds that your fitness to practise as a dentist is currently impaired by reason of your misconduct. There is a risk of repetition and public confidence in the profession would also be seriously undermined if no finding of impairment were made, given the seriousness of your misconduct.

Sanction

In deciding on what sanction (if any) to impose on your registration, the Committee balanced the mitigating and aggravating factors.

The mitigating factors are that you are of previous good character, with an unblemished career of over 40 years; you have no other fitness to practise history; you admitted many of the allegations at the outset of the hearing; you have taken some (albeit limited) remedial steps; and the reports from your workplace supervisor are very positive.

Your advanced age was put forward by Mr Hugh-Jones QC as a mitigating factor. The Committee noted that this is a sad case after so long in practice and in an otherwise unblemished career but concluded that it must decide sanction objectively and consistently.

Mr Hugh-Jones QC also advanced in mitigation that 4 ½ years have passed since the last of the events in question. However, in the Committee’s judgment, this was of limited significance, as the seriousness of your misconduct does not diminish with the passage of time. Indeed, from one perspective your failure to have used that time to adequately address and remedy your failings could more properly be characterised as an aggravating factor.

The Committee noted the testimonials you provided at this Stage of the proceedings and at Stage 1.

The aggravating factors are that your misconduct gave rise to a risk of harm to patients; your misconduct was sustained over a period of time; you acted dishonestly; your dishonesty was premediated and involved the abuse of trust of patients and the NHS; your dishonesty was serious, repeated and attempts were made by you to cover it up by retrospectively amending patient records as part of the GDC investigation; your dishonesty was for financial gain; you show no insight; you have breached a fundamental tenet of the profession and you show a blatant or willful disregard of the role of the GDC and the systems regulating the profession.

The Committee considered each sanction in ascending order of severity.

To conclude this case with no further action or a reprimand would be wholly inappropriate, owing to the seriousness of your misconduct and the risk of repetition.

The Committee next considered whether to direct that your registration be made subject to your compliance with conditions. The issue for the Committee is not whether you would comply with conditions of practice (you have complied with the interim conditions on your registration for the past 2 years) but whether conditions would achieve remediation and whether they would in any event be sufficient to maintain public confidence in the profession.

The Committee could not be satisfied that you would remedy your failings through conditions of practice. Although you have complied with the interim conditions you have not developed any meaningful insight or change of attitude to your clinical failings over the 2 year period your registration has been subject to your compliance with those conditions. In the Committee’s judgment, a more severe sanction would in any event be necessary to maintain public confidence in the profession. The attitudinal nature of your failings cannot be adequately addressed through conditions of practice. Your failings in respect of the NHS and CQC inspections and your dishonesty are too serious for conditional registration to be a proportionate sanction. Conditions of practice would not meet the requirement of public confidence in the profession.


The Committee next considered whether to direct that your registration be suspended for a period of up to 12 months, with or without a review. Whilst suspension might have been appropriate to address the clinical and record keeping failings in isolation it is not sufficient in the Committee’s judgment to address your dishonesty. This was additionally aggravated by other attitudinal failings in respect of which you show a lack of insight, which obstructs the process of remediation. These are very serious matters and you have acted in a way which is fundamentally incompatible with you remaining a registered dental professional. Public confidence in the profession and this regulatory process would be seriously undermined by allowing you to remain on the Register.

Unfortunately, the only appropriate and proportionate outcome in this case is that of erasure. It is not a decision which the Committee reaches with any enthusiasm, given the severity of the sanction and your otherwise long and unblemished career. However, it is the right decision in all the circumstances of this case. You used your position as a dentist to engage in serious and repeated acts of premeditated dishonesty for your financial gain. You subsequently attempted to cover up your fraud against the NHS by retrospectively altering patient records as part of the GDC investigation. You abused the trust Patients 1-9 and the NHS placed in you. You demonstrate a lack of remorse, reflection and insight into your dishonesty. Your dishonesty is compounded by wide ranging and significant failings identified in the NHS and CQC inspections, where patients were put at a real risk of harm through most basic failures in cross infection control. These failures and your subsequent lack of remediation are too serious for a period of suspension.

Accordingly, the Committee directs that your name be erased from the Register.

The Committee now invites submissions on the question of an immediate order.

_________________________________________________________________________

The Committee is satisfied that it is necessary for the protection of the public and is otherwise in the public interest to order that Ms Hopkins’ registration be suspended forthwith under s 30(1) of the Dentists Act 1984. In reaching its decision the Committee balanced the public interest with Ms Hopkins’ interests. It would be inconsistent with the decision the Committee has made not to make an immediate order to protect the public and to maintain public confidence in the profession.

The effect of this order is that Ms Hopkins’ registration is suspended immediately. Unless she exercises her right of appeal her name will be erased from the Register in 28 days’ time. Should she exercise her right of appeal, this immediate order will remain in force pending the disposal of the appeal.

The interim order on Ms Hopkins’ registration is hereby revoked.”

HEARING HEARD IN PUBLIC HOPKINS, Aileen Registration No ...

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