John A Green

Preliminary Matters

Private hearing in part

1. Ms Bass drew the Panel’s attention to rule 10 of the HCPC (Conduct and Competence) (Procedure) Rules 2003 (“the rules”) which allows the Panel a discretion to proceed with the hearing or part of the hearing in private.

2. Ms Bass submitted, as part of a joint application on behalf of the HCPC and the Registrant, that this hearing should be a hybrid hearing with parts to be heard in private and parts to be heard in public. She asked the Panel to use its discretion to hold any parts of the hearing relating to the Registrant’s health or family life in private.

3. Ms Barnfather supported the application.

4. The Panel took into account the advice of the Legal Assessor and the Health and Care Professions Tribunal Service (“HCPTS”) practice note ‘Conducting Hearings in Private’ dated March 2017. The Panel acknowledged that there is a strong public interest in ensuring that hearings are conducted in public for transparency. However, the Panel accepted the submissions made by Ms Bass and decided that parts of the hearing should be held in private. In reaching this decision the Panel had regard to the protection of the private lives of the Registrant, and his family. The Panel noted that there is information in the bundles which relates to the Registrant’s health and personal health information about members of his family. The Panel’s decision for part of the hearing to be held in private is to protect details of the Registrant’s health and the personal information relating to his family members.

5. The Panel noted that these health and personal matters could easily be separated from other evidence and therefore decided that it would be fair and proportionate to move in and out of private session rather than conduct the hearing wholly in private.

Amendment of Allegation

6. Ms Bass invited the Panel to amend the Allegation in the manner set out below, where bold represents a proposed insertion and strikethrough represents a proposed deletion:

As a registered Physiotherapist (PH39665): your fitness to practise is impaired by reason of your misconduct. In that:

1. You billed and received payments from AXA Health for sessions which did not take place, where invoices were produced on the following dates:

a. Service User 1 between 07 March 2017 and 16 May 2017.

b. Service User 2 between 11 April 2017 and 06 June 2017.

c. Service User 3 on 16 May 2017.

d. Service User 4 on 07 June 2017.

e. Service User 5 between 13 February 2017 and 16 May 2017.

2. You did not maintain clear and accurate record keeping in relation documentation prepared for accounting purposes relating:

a. Service User 1 between 07 March 2017 and 16 May 2017.

b. Service User 2 between 11 April 2017 and 06 June 2017.

c. Service User 3 on 16 May 2017.

d. Service User 4 on 07 June 2017.

e. Service User 5 between 13 February 2017 and 16 May 2017.

2. 3. Your conduct in relation to Particular 1 and/or 2 was dishonest.

3. 4. Your actions at Particulars 1, 2 and/or 2 3 amount to misconduct.

4. 5. By reason of your misconduct your fitness to practise is impaired.

7. Ms Bass submitted that the mischief in this case is that the Registrant billed AXA for treatment on dates that treatment was not provided. Ms Bass submitted that this is adequately articulated in Particular 1 and is a serious matter. To further allege that the records submitted to AXA [the invoices] were not clear or accurate would be duplicitous and does not affect the seriousness of the conduct alleged. She clarified that there is no evidence that patient clinical records were inaccurate, the patient records include only the dates that patients did attend for treatment.

8. Ms Bass also requested that the stem of the Allegation be amended to reflect the current HCPC drafting guidance. The misconduct and impairment are already pleaded and do not need to be repeated in the stem of the Allegation.

9. Ms Barnfather did not oppose the application.

10. The Panel heard and accepted the advice of the Legal Assessor. She reminded the Panel that it must consider whether such amendments would cause injustice to the Registrant or undermine his right to a fair hearing. The Panel should also ensure that the Allegation reflects the gravity of the Registrant’s alleged conduct of behaviour.

11. The Panel agreed to the amendments to the Allegation. The Panel concluded that such amendments would not create any unfairness to the Registrant and more accurately reflect the evidence in the case.

Admissions

12. The amended Allegation was read to the Registrant. The Registrant admitted to Particulars 1, 2 and 3.

13. Ms Barnfather submitted that she was not instructed to make submissions on impairment and that it would be a matter for the Panel to decide upon.

Background

14. The Registrant had, from April 2009, been providing physiotherapy services on AXA’s behalf at his private clinic in Brentwood, Essex (and subsequently at additional locations).

15. On 20 May 2021, AXA made a referral to the HCPC. The referral raised concerns that the Registrant had been billing AXA for physiotherapy sessions, on specific dates, which had not actually been attended to clients.

16. AXA investigated the concerns and contacted a number of patients. Their audit of the Registrant’s work raised a number of concerns which are now articulated in the regulatory Allegation. These related to the fee’s that the Registrant was allowed to charge under the terms of the contract with AXA ‘the agreement’, The treatment fees included all practitioner fees, staff and all consumables, equipment and facilities used, including any Practitioner's report. The fee agreement set out the
following:

(a) Initial physiotherapy appointment Including consultation, examination and treatment for new patients Charge £40.00

(b) Secondary physiotherapy appointment £40.00
Including ongoing treatment of current condition or assessment and treatment of new condition

(c) Extended physiotherapy appointment (in excess of 60mins) These will only be eligible in exceptional circumstances and where deemed clinically appropriate. All extended appointments must be pre-authorised. £80.00.

Evidence

HCPC

17. The HCPC relied on the evidence of SH - Senior Provider Investigator at AXA Health.

18. SH provided a statement dated 9 November 2023 which attached multiple exhibits.

19. By way of background to the matters, SH’s witness statement states as follows:

‘I have never personally met Mr Green but can confirm, pursuant to my role, that Mr Green entered into a contract with AXA to provide physiotherapy services for its members on 7 February 2005.

Initially, Mr Green was registered as an 'individual' provider, meaning that he could bill AXA solely for physiotherapy services that he had provided to our members himself.

Thereafter, in 2009, Mr Green approached AXA to be recognised as a 'clinic' provider…Being a clinic provider would mean that he could bill AXA not only for physiotherapy services provided by him, but also for those provided by other physiotherapists employed at his clinic…

Mr Green's request was agreed and, thereafter, on 10 August 2009, AXA entered into an agreement with him…as a 'clinic' provider…The agreement was a standardised agreement which was used by AXA with all clinic providers at the time. As per clause 1.3.1 of the agreement, it remained effective on a rolling basis until either party chose to terminate it pursuant to clauses 6.1, 6.2, 6.3 or 6.4.

On 17 September 2014, AXA authorised Mr Green to provide treatments for its members from additional clinic locations…

Pursuant to the agreement, Mr Green and the physiotherapists employed at his clinic were responsible for providing conventional physiotherapy treatments to AXA members. Appendix 2 of the agreement provided direction as to which treatments a provider could bill AXA for, and associated fees that could be charged. Beyond those directions, the mode of treatment was left to the discretion of the provider, provided it was conventional and was conducted in accordance with their regulatory obligations pursuant to their registration with the HCPC.

As the provider, once treatments had been provided to AXA members, Mr Green was then responsible for billing AXA.

Mr Green was expected to submit invoices to AXA, ideally via the 'electronic data interchange', which an electronic billing system commonly used in the insurance industry. Section 3 of the agreement details the fees that can be billed by the clinic provider to AXA. Clause 3.2 explicitly states that fees should only be for treatments which are medically necessary having regard to the Member's health condition and providing the Member is either under the supervision of a Specialist or is referred by their GP.

Pursuant to clause 5.2 of the agreement, it was a requirement of billing that any bills submitted to AXA by a clinic provider in the format and with the level of detail specified in Appendix 3.

When billing, a provider was not usually expected to provide proof that the treatment in question had been carried out. AXA expected its providers to operate in good faith and to only bill for services that they had actually provided. Clinical notes from treatments were also not required unless specifically requested by AXA, and it was rare for them to be requested.

Following the receipt of bills from providers such as Mr Green, payments were usually made via BACS from AXA to the provider in accordance with clause 5.3 of the agreement.
Concerns were first raised…on 4 July 2017.

The AXA internal investigation…was undertaken by [RH], Senior Provider Investigator. The investigation was taken over, for a period of time when [RH] was away from the office, by [DH]. However, on [RH’s] return, he resumed responsibility for the investigation.

[RH] commenced the internal investigation by conducting a review of all the internal documentation that AXA held in relation to the Premier Physiotherapy Clinic. [RH] ran billing reports to analyse the billing practices of the Premier Physiotherapy Clinic, which led to further investigation into Mr Green.’

20. SH’s statement provides further details of the AXA investigation stating that RH made telephone contact with various Service Users and he sent audit forms to 27 AXA members including Service Users 1,2,3,4 and 5. The statement notes that in these audit forms, the relevant members were asked to confirm their physiotherapist’s name, their treatment dates, how long each session had lasted for and that the treatment that had been billed to AXA had actually taken place.

21. SH’s statement notes that following telephone contacts and return of audit forms, AXA subsequently obtained the medical records of five Service Users.

22. SH’s statement notes that RH concluded his investigation on 20 May 2021. However, RH referred the concerns to the Insurance Fraud Department of the City of London Police on 20 March 2018. The Registrant was subsequently charged with six counts of fraud under sections 1 and 2 of the Fraud Act 2006.

23. SH’s statement notes that AXA determined that it would not pursue the prosecution if the Registrant agreed to repay AXA the sum of £4,400. The money was paid by the Registrant on 21 July 2021.

The Registrant

24. The Registrant did not challenge the contents of SH’s statement. The Registrant admitted the factual Allegation as particularised in Particular 1.

25. The Registrant provided a witness statement dated 06 May 2024 and a reflective statement dated 07 May 2024, together with multiple character testimonials.

26. In summary the Registrant’s evidence is as follows:

• He has been practising for some 38 years. He has not been subject to any previous complaints or findings and has never been called before the HCPC before.

• He looks at the whole patient holistically and does not solely concentrate on just the single most recent injury or immediate post-operative physiotherapy. He looks at developing the overall return to fitness and future injury prevention strategies for that particular patient, on the basis of a detailed understanding of the patient's history and lifestyle. He likes to think that he has a reputation for being a Physiotherapist who is able to help patients even where other Physiotherapists might have been unable to help them progress. His collaboration with highly experienced surgeons means that he has been able to help patients with complex problems and he has gained much pleasure from doing so.

• The AXA health contract allowed for an initial physiotherapy appointment to include consultation, examination, and treatment for new patients, to be charged at £40. It did not stipulate the duration of the appointment (save indicating the potential "in exceptional circumstances" to seek payments of £80 for pre-authorised sessions lasting over an hour).

• The 5 patients to whom the Allegation relate were rehabilitation patients. Most were referred to him by a group of specialist London Orthopaedic Surgeons, with whom he had worked with for many years. He could not provide the care that these patients required in a shorter physiotherapy session of approx. 15-20 minutes, and it was inconvenient for them to come for shorter but more frequent appointments. They largely preferred and required fewer but longer appointments and to his mind £40 for these lengthier sessions did not cover what was then his standard hourly rate of £140. He thinks this was the origin of his downfall: he arrogantly thought he was worth his hourly fee without further recourse to AXA and that therefore £40 remuneration covered only 15­ 20-minute appointments (which would only suffice for much less complex cases).

• With hindsight, looking back after 7 years of thinking about this, part of it was arrogance; that he felt that he 'deserved' his hourly rate, given the quality of the care which he was trying to give. Another, significant, part of it was a desire to give everyone what they wanted (i.e. a desire 'to please'): he wanted to please the surgeons by giving the best treatment and achieving excellent outcomes for patients; and to please patients by not rushing them and understanding their injuries and taking the time to help them to best recover (and accommodating their understandable disinclination to attend more often for shorter sessions). However, he now entirely appreciates that none of that justified misrepresenting to AXA on invoices that time spent was given on dates on which the patients did not in fact attend. He is now aware that he should have upheld a higher level of integrity, and he is embarrassed and disappointed in himself that he did not live up to the standards of a regulated professional. He recognises that what he did was dishonest.

• The Registrant’s written evidence is that at a Plea and Trial Preparation hearing on 17 May 2021, relating to the criminal case brought against him, His Honour Judge David Turner QC encouraged his lawyers to make representations to the Crown Prosecution Service (“CPS”) as to whether it was in the public interest to continue with the prosecution. In the light of the comments made by the Judge at that hearing, the CPS indicated that they would offer no evidence and effectively abandon the prosecution.

• He repaid the entire amount invoiced (£4,480) to AXA (not retaining fees for the sessions which did take place), recognising from the earlier investigation conducted by AXA that he should not have billed in the way that he did, that it was a breach of his contractual agreement with AXA, and he should simply never have agreed to work under such an agreement.

• At the criminal hearing in July 2021, the CPS offered no evidence to all counts and the judge entered not guilty verdicts to all counts.

• He recognises that at the time, he was not thinking about the fundamental importance of honesty and integrity to his dealings with everyone involved in his role as a Physiotherapist and a regulated professional. He was open with the patients whom he saw, but he was failing to 'see' AXA and how his actions looked from the public perspective. The public, and in this case, his patients, should expect and receive from him an approach to their care and treatment that does not bring his profession into disrepute. He is devastated at the choices that he has made whilst having a contract with AXA, which have damaged the profession to which he has devoted his adult life.

• To build upon his insight, in December 2022, he undertook a Probity & Ethics course run by the Professional Boundaries Company and since the start of December 2023 [Redacted].

• He wants to continue working in his profession. Physiotherapy is his passion.

• [Redacted]. Whilst acknowledging that he brought it on himself, he had to pay approximately £30,000 in legal fees while engaging with the AXA investigation and then the criminal prosecution. He still has five years left to pay on his mortgage, so the next few working years are crucial financially.

Submissions and Legal Advice

27. Ms Bass presented the case relating to Facts, Misconduct, and Impairment. For ease of reference, the submissions are set out separately under the appropriate headings below.

28. Ms Barnfather’s submissions are also set out separately under the appropriate headings below.

29. The Legal Assessor gave legal advice to the Panel relating to Facts, Misconduct, and Impairment, but emphasising that each stage must be taken in turn starting with the facts, then if required grounds, then if required impairment.

30. The Panel heard and accepted the advice of the Legal Assessor in respect of the approach to take in determining findings of facts and the burden and standard of proof. The burden of proof rests on the HCPC and it is for the HCPC to prove the Allegation irrespective of any admissions made by the Registrant. The Legal Assessor provided advice on the issues of credibility and reliability, as per the guidance in R (Dutta) v GMC [2020] EWHC 1974 (Admin). Advice was given on the test to be applied when considering a charge of dishonesty which is found in the guidance of the Supreme Court in Ivey v Genting Casinos (UK) LTD t/a Crockfords [2017] UKSC 67. The Panel was referred to the HCPTS Practice Note titled ‘Making decisions on a registrant’s state of mind’ dated November 2022.

31. The Panel heard and accepted the advice of the Legal Assessor in relation to Misconduct, which it must consider in the event, it finds one or more of the facts found proved. The Legal Assessor referred the Panel to the case of Roylance v GMC (no.2) [2000] AC 311 and to the HCPC Standards. The Legal Assessor advised that there was no settled definition of misconduct, and it was for the Panel to say in the circumstances of the case whether the behaviour, if found proven, crossed the threshold properly to be categorised as misconduct. The Panel could approach the question by deciding whether an act or omission on the part of the Registrant represented a serious falling short of the standards to be expected of a HCPC registrant. However, it is important to note that not every omission or wrongdoing necessarily constitutes Misconduct.

32. The Panel heard and accepted the advice of the Legal Assessor in relation to impairment. The Legal Assessor reminded the Panel to take into account that it should have regard to both the personal and public components and keep in mind the wider public interest. The Legal Assessor referred the Panel to the HCPTS Practice Note ‘Fitness to Practise Impairment’ dated November 2023. The Panel was referred to the cases of, CHRE v (1) NMC & (2) Grant [2011] EWHC 927 (Admin), Cohen v GMC [2008] EWHC 581 [Admin], Bolton v Law Society 1993, PSA v HCPC + Doree [2017] EWCA Civ 319 and The General Medical Council v Armstrong [2021] EWHC 1658 (Admin).

Decision on Facts

Particular 1 You billed and received payments from AXA Health for sessions which did not take place, where invoices were produced on the following dates: (a) Service User 1 between 07 March 2017 and 16 May 2017.

33. The Panel relied on the evidence of SH. The Panel placed significant weight on the evidence SH and felt confident in relying on it for the following reasons:

• SH’s evidence is not disputed by the Registrant. He did not ask for her to give live evidence indicating that he had no cross-examination.

• SH has no personal gain in these proceedings, she did not know the Registrant and only became involved with the HCPC investigation as part of her employment at AXA.

• SH’s witness evidence is supported by exhibiting contemporaneous documents, which were created in the course of business, such as the agreement between the Registrant and AXA.

34. The Panel took into account that in relation to Service User 1, the evidence shows that they telephoned RH on 08 September 2017 and a telephone transcript of that call is provided. Service User 1 subsequently returned their completed audit form to RH on 8 September 2017. RH had obtained the invoices sent to AXA by the Registrant in relation to Service User 1’s treatment. These invoices were sent on 7 March 2017 and 16 May 2017. RH had then prepared a table which compared the invoices received with respect to Service User 1, with the treatments that Service User 1 reported that they had received.

35. The Panel took into account that the Registrant has admitted this particular of the Allegation. It found that his admission was not made for reasons of duress or expediency and that it accorded with the evidence before the Panel from the HCPC.

36. The Panel also took into account that the findings of the AXA investigation were referred to the Police and it resulted in the CPS bringing a criminal case against the Registrant. This was ultimately dropped by the CPS once the Registrant had repaid the monies to AXA.

37. The Panel concluded that the evidence shows that on the balance of probabilities, the Registrant did bill and receive payments from AXA Health for sessions which did not take place, where invoices were produced in relation to Service User 1 between 07 March 2012 and 16 May 2017. 1(a) Found Proved.

Particular 1 You billed and received payments from AXA Health for sessions which did not take place, where invoices were produced on the following dates: (b) Service User 2 between 11 April 2017 and 06 June 2017.

38. For the same reasons as set out at paragraph 33 and 35 above the Panel placed weight on the evidence of SH and the admissions of the Registrant.

39. In relation to Service User 2, they returned their completed audit form to RH on 08 September 2017. RH obtained the invoices sent to AXA by the Registrant in relation to Service User 2’s treatment. Theses invoices were sent on 11 April 2017, 16 May 2017, and 6 June 2017. RH prepared a table which compared the invoices received with respect to Service User 2 with the treatments that Service User 2 reported that they received.

40. The Panel concluded that the evidence shows that on the balance of probabilities, the Registrant did bill and receive payments from AXA Health for sessions which did not take place, where invoices were produced in relation to Service User 2 between 11 April 2017 and 06 June 2017. 1(b) Found Proved.

Particular 1 You billed and received payments from AXA Health for sessions which did not take place, where invoices were produced on the following dates: (c) Service User 3 on 16 May 2017.

41. For the same reasons as set out at paragraph 33 and 35 above the Panel placed weight on the evidence of SH and the admissions of the Registrant.

42. In relation to Service User 3, they returned their completed audit form to RH on 16 July 2017, after which RH obtained the invoices sent to AXA by the Registrant in relation to Service User 3's treatment. These invoices were sent on 16 May 2017.

43. The Panel concluded that the evidence shows that on the balance of probabilities, the Registrant did bill and receive payments from AXA Health for sessions which did not take place, where invoices were produced in relation to Service User 3 on 16 May 2017. 1(c) Found Proved.

Particular 1 You billed and received payments from AXA Health for sessions which did not take place, where invoices were produced on the following dates (d) Service User 4 on 07 June 2017.

44. For the same reasons as set out at paragraph 33 and 35 above the Panel placed weight on the evidence of SH and the admissions of the Registrant.

45. In relation to Service User 4, they replied to RH via email on 21 August 2017 concerning the treatment sessions they had had with the Registrant. RH obtained the invoices sent to AXA by the Registrant in relation to Service User 4's treatment. These invoices were sent on 07 June 2017.

46. The Panel concluded that the evidence shows that on the balance of probabilities, the Registrant did bill and receive payments from AXA Health for sessions which did not take place, where invoices were produced in relation to Service User 4 on 07 June 2017. 1(d) Found Proved.

Particular 1 You billed and received payments from AXA Health for sessions which did not take place, where invoices were produced on the following dates (e) Service User 5 between 13 February 2017 and 16 May 2017.

47. For the same reasons as set out at paragraph 33 and 35 above the Panel placed weight on the evidence of SH and the admissions of the Registrant.

48. In relation to Service User 5, they returned their completed audit form to RH on 14 August 2017. RH obtained the invoices sent to AXA by the Registrant in relation to Service User 5's treatment. These invoices were sent on 13 February 2017, 07 March 2017 and 16 May 2017. RH prepared a table which compared the invoices received with respect to Service User 5 with the treatments that Service User 5 reported that they received.

49.The P anel concluded that the evidence shows that on the balance of probabilities, the Registrant did bill and receive payments from AXA Health for sessions which did not take place, where invoices were produced in relation to Service User 5 between 13 February 2017 and 16 May 2017. 1(e) Found Proved.

Particular 2 Your conduct in relation to Particular 1 was dishonest.

50. The Panel considered the written evidence, and the Registrant’s recent admission of dishonesty set out in his statement dated 07 May 2024. It also took into account the legal test on dishonesty as set out within case law and the HCPTS Practice Note.

51. The Panel first considered what the actual state of the Registrant’s knowledge or belief was as to the facts in which the alleged dishonesty arose. The Panel then went on to consider the question of whether the conduct was honest or dishonest by applying the objective standards of ordinary decent people with full knowledge of the facts of the case.

52. The dishonesty alleged relates to the billing and receiving of payments from AXA Health for sessions which did not take place, where invoices were produced in relation to five Service Users across a five-month period. The HCPC submit that the Registrant’s conduct was dishonest.

53. The Panel has already found that the Registrant did bill and receive payments from AXA Health for sessions which did not take place, where invoices were produced in relation to five Service Users (on various dates).

54. The Panel then considered what the Registrant knew or believed as to the facts and circumstances in which the alleged dishonesty arose.

55. The Panel considered that on all the evidence before it, that the Registrant did understand that the AXA health contract allowed for an initial physiotherapy appointment to include consultation, examination, and treatment for new patients, to be charged at £40. He should have been aware from the agreement that it did not stipulate the duration of the appointment (save indicating the potential "in exceptional circumstances" to seek payments of £80 for pre-authorised sessions lasting over an hour).

56. Despite knowing the terms of the AXA agreement which he entered into of his own free will, the Registrant billed and received payments from AXA Health for sessions which did not take place. This was not within the terms of the agreement and the Registrant would have known that. If the Registrant was unhappy about the level of remuneration offered by AXA, he could have made contact with them to discuss the terms of the agreement or he could have chosen not to undertake work for them. It was not until the Registrant was challenged by AXA in relation to the billing and receiving of payments that he acknowledged that he had misrepresented the invoices to account for what he thought he should have been paid in accordance with his usual charging rates.

57. The Panel concluded that taking into account the Registrant’s understanding of the circumstances, as set out above, an ordinary decent person would find the conduct was dishonest. The Panel considered that billing and receiving payment for sessions which did not take place would be held to be dishonest upon an objective test.

Grounds

HCPC

58. Ms Bass submitted that the Registrant has breached the following standards set out in the HCPC’s Standards of Conduct, Performance, and Ethics:

9. Be honest and trustworthy - Personal and professional behaviour

9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

59. Ms Bass submitted that the Allegation relates to conduct which is alleged to have occurred in relation to five Service Users and spanning a period of five months.

60. Ms Bass said that the admitted conduct in billing and receiving payments from AXA for sessions which did not take place was in itself misconduct and that doing so dishonestly also amounts to misconduct.

61. Ms Bass submitted that Physiotherapists occupy a position of trust and are expected to be honest and act with integrity, and failing to do so damages the reputation of the profession and could cause members of the public to lose confidence in Physiotherapists.

The Registrant

62. Ms Barnfather reminded the Panel that the Registrant had accepted at the outset of the hearing that his historical conduct in relation to the Allegation amounts to misconduct.

63. Ms Barnfather submitted that it was necessary for the Panel to accurately identify that the Allegation relates to the method of billing and that the treatment did not occur on those specific dates alleged, but that treatment for each of these five Service Users was provided by the Registrant.

Decision on Grounds

64. The Panel at all times kept in mind the HCPC’s overarching objective of protecting the public which includes protecting services users, protecting public confidence in the profession and the regulatory process, and declaring and upholding proper standards of conduct and behaviour.

65. The Panel took into account the HCPC Standards of Conduct Performance and Ethics. The panel bore in mind that a departure from the Standards alone does not necessarily constitute misconduct.

66. The Panel concluded that the behaviours of the Registrant in relation to Particulars 1 and 2 individually and collectively amount to serious professional misconduct.

67. The Panel concluded that the Registrant’s conduct and behaviour fell far below the standards expected of a registered Physiotherapist. The Panel determined that the Registrant’s conduct was in breach of the HCPC Standards of Conduct, Performance and Ethics, in particular standard:

‘9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.’

68. In relation to billing and receiving payments from AXA Health for sessions which did not take place, the Panel took into account that this was a deliberate and conscious decision of the Registrant to receive what he considered to be a fair day’s pay for a fair day’s work. Whilst he may have provided a good level of service for his clients, he nonetheless submitted bills for dates on which he did not see those Service Users and he knew that to be the case. Whatever his rationale and motivation for doing so, his conduct in sending bills and receiving payments for sessions which did not take place demonstrates a disregard for the trust that is placed in professionals who are expected to act with honesty and integrity.

69. The Panel found that the Registrant’s conduct in relation to Particular 1, which occurred in relation to five Service Users, over a period of five months, in the course of his work as a Physiotherapist, did amount to serious professional misconduct.

70. In relation to the proven dishonesty at Particular 2, the Panel acknowledged that this directly related to the conduct in Particular 1. The Panel considered that the conduct in dishonestly claiming financial remuneration to which the Registrant was not entitled did amount to serious professional misconduct. The Panel took into account that even though service users were not directly affected (as they did receive their treatment from the Registrant on other dates), dishonesty is generally recognised as one of the most serious forms of misconduct.

71. The Panel concluded that the facts found proven would be seen as far below what is expected by fellow practitioners and concluded that they amount to misconduct.

Impairment

HCPC

72. Ms Bass submitted that in reaching its decision on impairment, the Panel should have regard to the fact that the Registrant planned to bill AXA for more sessions than he was entitled to, and he executed that decision on a number of occasions over a five month period. Ms Bass submitted that the deception only stopped when the Registrant was caught out.

73. Ms Bass acknowledged the large number of positive testimonials provided by the Registrant and submitted that it was unlikely that the Registrant would repeat the exact same conduct. However, she submitted that it was for the Panel to decide whether it was satisfied that the Registrant would not act dishonestly again in the future in other ways, given that he tried to justify his dishonest behaviour (in claiming what he thought he was worth) and only stopped when he was caught.

74. Ms Bass reminded the Panel of the public interest tending to a finding of impairment in cases of dishonesty.

The Registrant

75. Ms Barnfather submitted that impairment was a matter for the Panel but referred it to the clear evidence of remediation before it.

76. Ms Barnfather referred the Panel to a letter from the Registrant’s solicitor to the HCPC in 2022 during the investigation stage. In part this states:

‘There have never been any previous or subsequent similar concerns about Mr Green: indeed no concerns about Mr Green have ever been raised with the HCPC.

He has taken significant steps to reflect on and remediate his practice, as outlined above. Significantly, he has repaid the sums involved. Mr Green has learned a very salutary lesson and, in our submission, not only is his fitness to practise not currently impaired but there is no public interest in pursuing this matter any further.

Mr Green self-reported to the HCPC and has spent the last 5 ½ years feeling entirely ashamed of his actions. Mr Green is a highly ethical person with a deep conscience. His profession is of fundamental importance to him and he has worked extremely hard always to be at the pinnacle of the profession clinically, but also ethically.

To work with such demanding patients and surgeons and never to have even had a complaint speaks volumes about his diligence, dedication and the level of skill and professionalism he brings to the job.

Mr Green will never repeat such behaviour. He thinks about and regrets his conduct every day. He feels that he has lived under the cloud caused by this conduct for the last 5 ½ years. He has learnt his lesson and remediated any shortcomings. He remains an outstanding – indeed exemplary – clinician who delivers much benefit to his patients.’

77. Ms Barnfather submitted that there was no basis on which the Panel could find a risk of repetition and that this was not a case in which the public or patients had been placed at risk. Ms Barnfather submitted that issue of impairment in this case for the Panel to consider is that which is related to public confidence in the Physiotherapy profession and the maintenance of professional standards.

Decision on Impairment

78. The Panel considered the Registrant’s current fitness to practise firstly from the personal perspective and then from the wider public perspective. The Panel also had regard to whether the conduct in this case is easily remediable, whether it has been remedied and whether it was highly unlikely to be repeated.

79. In deciding current impairment, the Panel had regard to the factors identified by Dame Janet Smith in her 5th Shipman Report and cited in CHRE v (1) NMC and (2) Grant. The Panel considered whether:

a- The Registrant has in the past and/or is liable in the future to place service users at unwarranted risk of harm.

b- The Registrant has in the past brought and/or is liable in the future to bring the profession into disrepute.

c- The Registrant has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession.

d-The Registrant has in the past acted dishonestly and/or is liable to act dishonestly in the future.

80. In relation to the first component the Panel determined that the Registrant had not placed service users at unwarranted risk of harm. The facts found are limited to misconduct by the Registrant in relation to dishonestly billing and receiving payment for invoices for dates which he purported to have seen Service Users but did not do so. However, he did see and carry out appropriate treatment for the Service Users on other dates, so their treatment was not in any way impacted and they were not placed at risk of harm.

81. In relation to the question of whether the Registrant has in the past brought the profession into disrepute, the Panel determined he had. A significant aspect of public interest is upholding proper standards of behaviour so as not to bring the profession into disrepute. The dishonest conduct does bring the profession into disrepute as the public rely on registered professionals to work with honesty and integrity.

82. In finding that the Registrant did not conduct himself in such a way as to adhere to the HCPC Standards, as per its findings on misconduct, the Panel determined that he had breached fundamental tenets of the profession. The Panel considered that trust and honesty are fundamental tenets of Physiotherapy practice.

83. In relation to the fourth component, the Panel determined that the Registrant had in the past acted dishonestly, when he billed and received payment from AXA for sessions which did not take place.

84. The Panel considered the extent to which the misconduct in this case can be and has been remediated by the Registrant and whether it is likely to be repeated.

85. Whilst the Panel acknowledged that the misconduct in this case includes dishonesty, which can be attitudinal in nature, and thus harder to remediate, it did conclude that the misconduct in the circumstances of this case is remediable. It considered that in order to remediate the Registrant would need to show fully developed insight, an acceptance that what he did fell far below professional standards, show an understanding of how and why it occurred and its consequences for those affected. It considered it would need to see evidence to demonstrate that the Registrant has taken action to address his misconduct in a manner which remedies any past harm and avoids any future repetition.

86. The Panel placed weight on the written evidence and written reflection provided by the Registrant in advance of the hearing. The Panel accepted that he has developed insight and recognised the gravity of his actions. The Panel considered that his insight started with his acceptance of wrongdoing when challenged by AXA in 2017 and included the full repayment in 2021 of the monies he had dishonestly received from AXA.

87. Whilst the Panel noted that the Registrant had only admitted the dishonesty part of the HCPC Allegation in his statement dated 7 May 2024, it acknowledged that he had never sought to deny his actions once challenged. In the letter from his solicitor to the HCPC in October 2022, the Registrant accepts that his invoicing of AXA relating to the five Service Users was misleading and wrong and that ‘he should not have manipulated the contract’ by invoicing for sessions on dates when such sessions did not take place.

88. The Panel found that the Registrant had been able to articulate an understanding of how and why the dishonesty occurred, candidly saying it was a result of his own arrogance in believing he was worth more than the £40 per hour that AXA were paying and also as a result of his need to ‘people please’. The Panel found that in the significant period of time that has passed since the events, the Registrant has been able to reflect on the consequences of his actions. He now recognises that his actions not only impacted AXA but also the wider public. He acknowledged that ‘the public, and… patients, should expect and receive from myself an approach to their care and treatment that does not bring my profession into disrepute.’

89. The Panel determined that the Registrant has taken responsibility for his actions, and he has repaid the money he received from AXA. He has fully engaged with the AXA investigation, the HCPC investigation and the HCPTS fitness to practise hearing.

90. In relation to actions taken by the Registrant to demonstrate remediation, the Panel took into account that he had in December 2022 completed a Probity & Ethics course (run by the Professional Boundaries Company) in December. This is relevant training given the nature of the findings that have subsequently been found against him. The Panel also placed weight on the fact that the Registrant has sought professional help [Redacted]. The Panel took into account the testimonial provided by [Redacted] in which she states, ‘[The Registrant] has acknowledged to me he knows his actions were both wrong and dishonest, [Redacted]. The testimonial further states, ‘I believe [the Registrant] to be genuinely remorseful for his actions and he accepts the misery the last few years has consisted of are entirely self-made.’

91. The Panel placed weight on the fact that the Registrant has had a long career as a registered Physiotherapist and has not been subject to any fitness to practise concerns before 2017. He has also continued to work as a registered Physiotherapist from 2017 to present and no further concerns have been raised about his willingness or capacity to observe his professional duties and abide by the HCPC Standards.

92. The Registrant provided evidence of multiple testimonials/references from professionals he works with and patients he treats. These all support his assertion that he is held in high regard in relation to his clinical practice. Many of these testimonials reference the current proceedings demonstrating an openness from the Registrant to have shared details of his wrongdoing to those who continue to place their trust in him despite his conduct in 2017.

93. Based on all the information before it, the Panel concluded that the Registrant’s actions taken in relation to the facts found, was behaviour that would not be repeated. The Panel concluded that the Registrant has remediated, and that in all the circumstances the risk of repetition is very low. Therefore, the Panel did not find personal impairment.

94. The Panel next considered whether a finding of current impairment was necessary in the public interest. The Panel was mindful that the public interest encompassed not only public protection but also the declaring and upholding of proper standards of behaviour as well as the maintenance of public confidence in the profession. It took into account the guidance in Grant at paragraph 74:- ‘In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.’

95. The Panel considered its findings in relation to misconduct including the finding of dishonesty. The panel took into account that Physiotherapists hold privileged positions of trust. It is essential to the effective delivery of Physiotherapy that the public can trust Physiotherapists to act with decency, honesty, and integrity. Whilst the Registrant’s conduct did not impact on public safety, nor is he likely to present a future risk to service users, he did engage in a course of dishonest conduct relating to five Service Users across a five-month period. The conduct was such that it resulted in criminal proceedings that were ultimately ‘dropped’ as a result of the Registrant repaying AXA.

96. The Panel took into account that the Registrant’s dishonest misconduct was a deliberate action at the time, believing he was worth more than AXA were paying under the terms of the agreement. His actions had resulted in financial gain for him, although, it accepted that he had repaid the money to AXA once his actions came to light.

97. The Panel considered that members of the public, even if they knew that the Registrant has remained in competent and positive practice, would be concerned if the Regulator were not to mark the seriousness of the Registrant’s misconduct with a finding of current impairment on public interest grounds. The Panel considered that not to make a finding of current impairment of fitness to practise in relation to the dishonest misconduct would seriously undermine public trust and confidence in the profession and would fail to uphold and declare proper standards.

98. The Panel therefore decided on the public interest element of impairment that the Registrant’s fitness to practise is currently impaired.

Sanction

99. Ms Barnfather informed the Panel that the Registrant would be giving oral evidence and that he was calling four character witnesses to give oral evidence.

100. Due to ensuring that the hearing progressed in a timely manner, the Panel agreed that the witnesses could be called prior to the Registrant giving evidence.

101. The following character witnesses gave evidence under affirmation. They were taken through their written testimony by Ms Barnfather and were asked questions by Ms Bass and/or the Panel:

- AW - Consultant Orthopaedic Surgeon specialising in sports-related knee problems.

- AA - Consultant Specialist Knee Surgeon with a particular sub-speciality area of interest in soft tissue knee surgery.

- YK - Consultant Solicitor Advocate – who provided testimony as a patient of the Registrant’s rather than in a legal capacity.

- KB – A patient of the Registrant for many years.

102. AW, AA, YK and KB all said that they were aware of the allegations which the Registrant faced. AW and AA said they held the Registrant in high regard. They had both known the Registrant professionally for a significant number of years and ranked him as one of the best Physiotherapists in London.

103. AW said that the Registrant’s results for patients are better than the average and if the Registrant were unable to practise AW would have to make alternative arrangements for his complex cases. He was shocked by the behaviour of the Registrant but still considered him to be trustworthy. He accepted it was a serious transgression but appeared to him to be isolated. He would still continue to send work to the Registrant.

104. AA spoke in similar terms to AW. AA explained that he would still send referrals to the Registrant even if he was out of practice for a while, however, he said that the referral market was a ‘fickle ecosystem’ and that he thought reestablishing links after a period of absence could be very difficult and that patients would not achieve the outcomes they could have done if the Registrant had been allowed to treat them. Given the dishonest conduct, as a professional, he thought the behaviour fell below what was expected and should be dealt with by an appropriate sanction, noting that the public place trust in healthcare professionals and hold them to a high standard.

105. YK and KB spoke in depth about the significant contribution that the Registrant had made to them and set out the life changing impact that his standard of physiotherapy had on them. They were both concerned about the impact on other patients, (both future and current, including themselves) if the Registrant were not able to practise as a Physiotherapist.

106. The Registrant gave evidence under affirmation. At the outset before he spoke in chief, he gave, what the Panel considered to be, a clearly articulated apology which acknowledged his understanding of the impact his conduct had on those not only directly involved but also fellow regulated professionals and the wider public interest.

107. The Registrant spoke to the contents of his witness statement and his written refection which are already set out in summary elsewhere in this decision. He talked in further depth about his arrogance and how on reflection he believed that had been part of his downfall in acting how he did. He spoke about it not being acceptable for him to have discussed with the five Service Users how he was going to bill AXA for shorter, but more numerous sessions than actually took place, due to the issues with AXA’s low rates. He reflected that this was of no concern to the Service Users, and he should have been focused on their treatment not on his rate of payment.

108. The Registrant thought that the probity and ethics course had been helpful to him to understand what he did from another perspective. He had felt an injustice towards AXA for paying such a low rate, but it was explained to him by the course leader that AXA was akin to a shop keeper and that you would not go into a shop and help yourself without paying. He accepted in answer to questions from the Panel that he could have had an annual review of rates as per clause 3.5 of the AXA agreement. He accepted he could have challenged AXA about the rates, but he did not want to do so as he has previously been criticised by AXA as to the duration of treatment he had provided.

109. The Registrant spoke about the devastating impact that it would have if he could not practise, on him, his wife, his finances, and his patients.

110. The Registrant did not think a member of the public would have a positive reaction to what he had done but that he hoped that they would see it as isolated misconduct within the context of someone who made a wrong decision and would be dealt with appropriately.

Submissions

111. Ms Bass said that it was not HCPC policy to advocate for a particular sanction and referred the Panel to the HCPC Sanctions Policy dated March 2019.

112. Ms Bass submitted that the Panel might consider that the aggravating features of this case included, that the conduct was deliberate dishonesty, repeated a number of times, and involved a breach of trust with AXA.

113. Ms Bass acknowledged that there are mitigating features including, repayment of the money to AXA, insight, remorse and remediation.

114. Ms Barnfather made oral submissions but also provided a nine-page document of written submissions which the Panel read before reaching its decision on sanction.

115. In summary Ms Barnfather submitted:

‘Whilst the dishonesty in the index case was repeated involving the submission of invoices containing fictitious dates on five separate occasions between February 2017 and June 2017, the dishonest conduct (as averred and admitted) is confined to the method of his billing which was deliberately misleading. This is not, however, a case of dishonestly obtaining payment for treatment which had never been provided, rather it concerns dishonesty in respect of the way in which payment was obtained in order to achieve the practitioner’s normal private hourly rate for the care and treatment that was actually delivered and hence the dishonesty involved in this case is not of a nature or degree that calls for the highest sanction.

It is to be noted that the Registrant was permitted by the terms of the AXA agreement to provide unlimited sessions to the patients in question and, had he broken down the sessions and provided multiple shorter sessions on different dates and invoiced accordingly, he would have been entitled to the payments obtained. Additionally, it is to be observed that the patients were neither deceived nor harmed by the dishonesty. The Registrant was open with patients about the difficulties with regard to his renumeration by AXA and patients were aware that the longer sessions were billed as separate sessions and to this extent he was open and there was no substantial breach of patient trust. The Registrant fully appreciates that higher standards of integrity and honesty are expected of a professional and genuinely regrets he did not live up to those higher standards. The position remains, however, that the dishonesty was not against or at the expense of any patient.

The conduct came about as a result of the Registrant’s genuine desire to treat these particular patients in the most efficient and effective way whilst being renumerated in accordance with his usual fee. His core failings were his conceit in unilaterally determining he was entitled to his private hourly rate and thereafter seeking to obtain that payment via the submission of invoices containing false treatment dates. Surprisingly, and to his shame, he did not at the time fully appreciate the gravamen of invoicing false dates. The Registrant wrongly considered himself justified in obtaining the funds themselves but did not set out to deliberately cheat AXA of what he knew to be unmerited additional payments. It was a dishonest means to achieve what the Registrant mistakenly considered a justifiable end.

The dishonesty was confined to a five-month period now some 7 years ago and involves a total of 5 patients who held insurance cover with one specific company. (All other insurance companies such as Bupa Global, Cigna, WPA and Aviva paid the Registrant’s normal private hourly rate). The dishonesty was not, furthermore, sophisticated nor covered up (for example there was no falsification of records as may be seen in other cases).

It follows from the above that the dishonesty in this case is not amongst the most egregious in that:

(i) The dishonest conduct is limited to the manner in which the registrant obtained funds for treatment, funds which were otherwise available to him;

(ii) It was not motivated by a desire for a financial or personal gain over and above his normal private fee;

(iii) It did not involve a risk to patient safety or care and the registrant can, and has continued to practise safely;

(iv) It did not involve a breach of patient trust;

(v) It was more opportunistic than sophisticated and did not involve any cover-up or recruitment or coercion of others;

(vi) It was confined to the particular circumstances involving one specific insurance company;

(vii) It was limited to 5 patients and sums at the more modest end of the scale;

The dishonesty has been admitted and restitution made in full.’

116. Ms Barnfather made submissions on the Registrant’s good character and contribution to the profession, his insight, the negligible risk of repetition, the historical nature of the misconduct, and the Registrant’s positive conduct in the intervening years.

117. Ms Barnfather submitted that the requirements of the public interest would be adequately vindicated in this particular case by the finding of current impairment and the imposition of a Caution Order. Ms Barnfather addressed the Panel on each of the sanctions in turn and submitted that a Striking Off Order would not be proportionate or necessary in this case.

118. The Panel heard and accepted the advice of the Legal Assessor, who referred the Panel to the HCPC Sanctions Policy, which states that any sanction must be proportionate, is not intended to be punitive and should be no more than is necessary to meet the legitimate purposes of providing adequate protection to the public, to protect the reputation of the profession, maintain confidence in the regulatory system and declare and uphold proper professional standards. In respect of the Panel’s findings of dishonesty, the Legal Assessor drew the Panel’s to paragraphs 56-58 of the Sanctions Policy and reminded the Panel that the case law in relation to dishonesty make plain that a finding of dishonesty will always be considered to be serious and risk serious consequences. However, a more nuanced approach should be taken to dishonesty, and dishonest conduct can take various forms; some criminal, some not; some destroying trust instantly, others merely undermining it to a greater or lesser extent. Not all cases of proven dishonesty will lead to strike off.

Decision on Sanction

Panel’s decision

119. The Panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of severity. The Panel considered the mitigating and aggravating factors in determining what sanction, if any, to impose.

120. The Panel identified the following aggravating factors:

- The repeated dishonesty which related to dishonestly billing AXA in relation to five Service Users across a period of five months.

- The dishonesty was deliberate. The agreement provided a review mechanism, but the Registrant did not contact AXA to negotiate the terms, instead deciding to claim what he considered to be the appropriate rate by manipulating the way he billed AXA.

- The billing for sessions which did not take place breached the trust between AXA and the Registrant.

121. The Panel identified the following mitigating factors:

a. There was no direct patient harm.

b. The Registrant has developed good insight, has reflected at length over the last seven years, and he has demonstrated remediation.

c. The money the Registrant received from AXA was repaid to AXA in around July 2021.

d. The Registrant has fully co-operated with the investigations into the concerns and with the fitness to practise process. He admitted the basis of what he had done as soon as he was challenged, albeit he did not formally admit the pleading of dishonesty until 7 May 2024.

e. There have been no previous regulatory matters raised against the Registrant during his long career as a Physiotherapist. No further concerns have been raised since these concerns in 2017, during which time the Registrant has remained in unrestricted practice. The misconduct found against the Registrant appears to be a departure from his usual standard of professional behaviour.

f. No concerns have been raised regarding the Registrant’s professional competence or his unwavering commitment to the profession. Indeed, the Panel had sight of numerous professional references attesting to the Registrant’s skills and expertise and heard live evidence about the high regard in which the Registrant’s clinical work is held.

122. The Panel took into account Ms Barnfather’s submissions that a relevant mitigating factor was that it had taken seven years to come to a final hearing. Seven years during which the Registrant had been subject to investigation. The Panel accepts this is a lengthy time frame, however, the investigation was as a direct consequence of his dishonest conduct. The Panel was also aware that it took some four years for the criminal case against the Registrant to come to trial, at which stage it is understood that the CPS offered no evidence as a result of the Registrant having recently repaid the monies to AXA.

123. Ms Barnfather in her submissions, made reference to the fact that the criminal judge had referred to the lack of public interest in the pursuit of criminal proceedings. However, the Panel had not seen any evidence as to what had happened in the criminal court in July 2021. The Panel did have regard to the written representations made by the Registrant’s legal representative to the HCPC in October 2022. These indicated that the reason the CPS did not offer any evidence at trial was because the Registrant had repaid the monies to AXA shortly before the date of the trial.

124. The HCPC Sanctions Policy states: ‘The Standards of conduct, performance and ethics require registrants to be honest and trustworthy (Standard 9). Dishonesty undermines public confidence in the profession and can, in some cases, impact the public’s safety. Dishonesty, both in and outside the workplace, can have a significant impact on the trust placed in those who have been dishonest, and potentially on public safety. It is likely to lead to more serious sanctions…Given the seriousness of dishonesty, cases are likely to result in more serious sanctions. However, panels should bear in mind that there are different forms, and different degrees, of dishonesty, that need to be considered in an appropriately nuanced way. Factors that panels should take into account in this regard include:

• whether the relevant behaviour took the form of a single act, or occurred on multiple occasions;

• the duration of any dishonesty;

• whether the registrant took a passive or active role in it;

• any early admission of dishonesty on the registrant’s behalf; and

• any other relevant mitigating factors.’

125. The Panel started by considering the least restrictive sanction first, working upwards only where necessary. The final sanction should be a proportionate approach and will therefore be the minimum action required to protect the public.

126. Due to the serious nature of the misconduct in this case (financial dishonesty) the Panel considered that taking no further action would not be appropriate in this case.

127. The Panel next considered whether a Caution Order would be appropriate. The Panel considered that a caution order would not be in accordance with the HCPC Sanctions Policy which states: ‘A caution order is likely to be an appropriate sanction for cases in which: the issue is isolated, limited, or relatively minor in nature.’ The Panel considered its earlier decision on misconduct and impairment, noting that there is a low risk of repetition, the Registrant has shown good insight (this was expanded further in his oral evidence), and he has undertaken appropriate remediation.

128. However, for the following reasons, the Panel concluded that the misconduct was not minor in nature. The dishonest misconduct was not isolated in that it related to five Service Users spanning a five-month period. On his own evidence, the Registrant deliberately set out to misrepresent to AXA insurance how he had delivered treatment sessions to the five Service Users. He falsified the billing in order to receive financial gain for what he saw as his professional worth, instead of negotiating the agreement with AXA (he assumed there was little point doing this knowing that he had previously had issues with AXA on which they would not budge) or ceasing the agreement to offer services. The Registrant’s premeditation in doing this involved speaking to the Service Users about how he was going to bill AXA due to it being so much lower than his usual charging rate. The Registrant’s misconduct was sufficiently serious to be prosecuted by the CPS for fraud by false representation under Sections 1 and 2 of the Fraud Act 2006, albeit the case was ultimately ‘dropped’ as the money was repaid by the Registrant to AXA shortly before the trial in July 2021.

129. In the circumstances the Panel considered that the Registrant’s misconduct was too serious for a caution.

130. The Panel next considered whether to impose a Conditions of Practice Order. The HCPC Sanctions Policy states: ‘Conditions are also less likely to be appropriate in more serious cases, for example those involving dishonesty.’ The HCPC Sanctions Policy also states that: ‘There may be circumstances in which a panel considers it appropriate to impose a conditions of practice order in the above cases [dishonesty]. However, it should only do so when it is satisfied that the registrant’s conduct was minor, out of character, capable of remediation and unlikely to be repeated’.

131. As set out at paragraph 126 above, the Panel was not satisfied that the Registrant’s conduct was minor. Whilst the Panel had found a low risk of repetition of dishonest conduct in future, the nature of the misconduct was such that the Panel did not consider that a Conditions of Practice order would meet the public interest elements of the overarching objective. Registration with the HCPC is a Kitemark of assurance to the public not only that they will be protected but also that standards will be upheld, and that confidence can be maintained in the HCPC as the regulator. The Panel considered that conditions of practice could not be formulated in this instance to meet these public interest objectives.

132. The Panel next considered a Suspension Order. The HCPC Sanctions Policy states: ‘A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register.’

133. The Panel’s findings of misconduct and impairment recognise that Physiotherapists hold privileged positions of trust. It is essential to the effective delivery of Physiotherapy that the public can trust Physiotherapists to act with decency, honesty, and integrity. Whilst the Registrant’s conduct did not impact on public safety, nor is he likely to present a future risk to service users, he did engage in a course of dishonest conduct relating to five Service Users across a five-month period, which represents a serious breach of the HCPC Standards of conduct, performance and ethics. The Registrant in his oral evidence captured the importance of public trust in the health care sector. In summary he said that relationships with other medical professionals rely on trust, and without that trust, the ability to deliver patient care will break down.

134. Having considered that the circumstances of this case do raise serious concerns that cannot be reasonably addressed by a Conditions of Practice Order, the Panel concluded that a Suspension Order would be necessary to meet its objectives. It considered that this would also be a proportionate order recognising the personal and professional interests of the Registrant as outlined in his evidence.

135. The Panel concluded that a Suspension Order would be appropriate as the Registrant has developed considerable insight into his conduct, has demonstrated significant remediation such as taking steps to resolve and remedy his failings, by repaying the money to AXA, undertaking relevant CPD training, being open about these proceedings with the people he works with and for, and [Redacted].

136. The Panel took into account its finding that the conduct did not put patients at risk and was unlikely to be repeated. It therefore considered that a short-term suspension would be appropriate in order to maintain public confidence in the professions and uphold standards.

137. The Panel decided that a three-month Suspension Order should be imposed. The Panel decided this would be the appropriate length taking into account the level of insight and remorse shown, whilst balanced against the need to maintain public confidence and send a clear message that financial dishonesty is not acceptable behaviour. The Panel considered that a three-month Suspension would also take into account and balance the public interest in allowing a competent and experienced Physiotherapist to be allowed to practise, particularly for those complex patients that the Registrant is involved with treating.

138. The Panel decided that any duration longer than three months would be punitive and would not be proportionate taking into account all it had read and heard about the Registrant’s professional and personal interests. The Panel considered that a period of three months suspension would not de-skill the Registrant from his evident proficiency as a Physiotherapist nor would it have any significant negative impact on what has been described by witness ‘AA’ as a ‘fickle eco-system’ in terms of referrals in the healthcare system.

139. The Panel did move on to consider whether this was a case that would more properly merit a striking-off order. The Sanctions Policy states: ‘A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process.’

140. The Panel considered a Striking-Off Order would be unduly punitive in this case despite the Registrant’s dishonesty due to the numerous mitigating factors identified above.

141. The Panel considered that the misconduct in this case was such that the requirements of public protection and the wider public interest would be adequately served by imposing a three-month Suspension Order. The Panel had regard to proportionality and balanced the public interest against the Registrant’s interests. The Panel took into account the consequential personal, financial and professional impact a Suspension Order may have upon the Registrant, bearing in mind his oral evidence, but concluded that these considerations are outweighed by the Panel’s duty to give priority to the public interest.

 

ORDER: The Registrar is directed to suspend the registration of John A Green for a period of three months from the date this Order comes into effect.

No notes available

History of Hearings for John A Green

Date	Panel	Hearing type	Outcomes / Status
08/05/2024	Conduct and Competence Committee	Final Hearing	Suspended