Dr Mohamad Alruby v NHS England

This tribunal can make any decision which the Respondent could have made (Regulation 17(4)). This is a rehearing.

The issues in the appeal concern the imposition of conditions (“the conditions”) upon Dr Alruby’s inclusion in the performers list (“PL”). The conditions are found in the decision letter dated 2.4.25 (page 76-82 at 80/81 following the meeting of the Respondent’s Performers List Decision Panel (“PDLP”).

Dr Alruby seeks unconditional inclusion upon the PL.

NHSE seeks continuation of the conditions.

Dr Alruby made an application both for postponement/adjournment of the hearing of this appeal and for disclosure which were refused by Judge Khan on 29.10.25. This panel does not and cannot act as an appeal court from that decision. There have been several more informal applications in emails subsequent to 12.11.25 seeking a stay or postponement. They are also in effect an attempt to appeal Judge Khan’s decision. They do not include any evidence of events subsequent to either his decision or our hearing which were not available earlier. There are various references both to the GMC continuing investigation and judicial review proceedings. We received no reasoned argument why this appeal should await the outcome of either. This tribunal is independent of other jurisdictions and has to follow its own statutory regulations and procedure. Even if there had not been an earlier decision by Judge Khan we would not have adjourned this appeal. This appeal is a re-hearing leading to a decision based upon the evidence presented to us by both parties.

Dr Alruby sent an email to the tribunal on 11.11.25 at 08.24 (the same email address as has been used throughout by the tribunal and the Respondent) indicating that he was taken by surprise by the hearing taking place on 11.11.25. Emails from the tribunal on 14.10.25, 7.11.25 and 10.11.25 clearly gave notice of the hearing. Apart from any other communications between the parties, the bundle prepared by the Respondent and their skeleton argument also contain references to the hearing date. When asked at the beginning of the hearing whether he was making an application to delay or adjourn the hearing he replied “No. Get on (with the appeal)”. At that point he gave no indication that he was unprepared to present his appeal. Shortly after noon during his cross-examination of Mr Riggs (Mrs Hazell having already given evidence) , Dr Alruby said that he had not read anything in the bundle and had not been able to open it. He had made no such previous reference to either the Respondent or the tribunal. He did not make an application or request but the panel decided to adjourn at that point and at our request a member of staff of the Respondent assisted him to open the bundle whilst we adjourned to 2.30pm. Following our specific request he said that he did not want more time to read the bundle (and on the following morning, after having had the evening to read it further he did not raise any matters arising from further reading of the bundle).

Dr Alruby did not comply with the directions of 6.6.25 and in particular did not respond to the Respondent regarding the witness list, essential reading list, chronology or case summary until 20 October 2025. He also sent his completed response to the Scott schedule on 20 October 2025. The Respondent made no objection to any documents because of their lateness.

We were provided with both a bundle and a supplemental bundle of written evidence. We have read the written skeleton argument of the Respondent, and we have also read the various written submissions from Dr Alruby. The written evidence is substantial and must be read in conjunction with this decision. The oral evidence was over several hours and this decision contains only a summary of parts of it.

The chronology (page 74/5) sets out the history of Dr Alruby working in optometry since 2019. Neither party has indicated relevant facts or issues prior to that time, albeit we note that Dr Alruby qualified as a doctor and worked in ophthalmology.

His initial practice in optometry was at Specsavers in New Milton 2019-22. Following concerns being raised relating to glaucoma referrals, NHS South West PAG advised a number of actions (page 295) to be undertaken but on 26.9.22 Dr Alruby asked for his name to be removed from the PL. He thereafter worked in ophthalmology as a locum at Princess Alexandra Hospital Harlow and Birmingham Midlands Eye Centre. Concerns were notified by his Responsible Officer (“RO”) in August 2024 (page 308). Those concerns led to consideration by the GMC which is still ongoing. The Interim Orders Panel (“IOP”) did not consider an interim order required but there has as yet been no final decision. We have not been shown any documents from the GMC and in particular have not been shown expert reports which have been written (seen by Dr Alruby but not by the Respondent).

In June 2024 Dr Alruby applied to rejoin the PL.

The PLDP met in November 2024. As more fully set out in their letter (page 90-94) they considered the concerns in 2022 which were not resolved before Dr Alruby’s voluntary leaving the PL, and the still unresolved allegations of clinical substandard care at Harlow and Birmingham being investigated by the GMC. They considered that such unresolved concerns required conditions upon practice to ensure the protection and safety of patients and provision of efficient services. They advised Dr Alruby of their proposed conditions and offered various methods by which he could make representations against such conditions. He decided not to do so and accepted the conditions. The principal conditions were that he must work in no more than 2 practices and with a work place approved supervisor, together with various requirements for audit and keeping NHSE updated (set out in full at pages 92/3).

In December 2024 Dr Alruby started work as an optometrist at Specsavers in Newport in the Isle of Wight with Mr Riggs as his supervisor. There followed monthly supervision meetings in January and February 2025. The reports noted various areas as “Needs further development”. There was an incident in February when he had fallen asleep during an examination of a patient. Prior to the March supervision meeting, on 6.3.25 Dr Alruby requested NHSE to review the conditions and on 7.3.25 resigned from Specsavers.

Review of the conditions took place at a hearing on 1.4.25 at which Dr Alruby was present. There are minutes of that meeting (pages 354-66) and the decision letter of 2.4.25 (pages 76-82) summarises the discussion and sets out the decision to continue the previous conditions with the addition of 2 further conditions requiring an induction programme at each new place of work and an occupational health assessment. Considerations included no further evidence to assuage previous concerns, the matters noted by Mr Riggs as requiring further development, a lack of insight and reflection, and lack of recognition of the potential impact on patient safety of his own health issues. That is the decision which is the subject of this appeal. We interpose the observation that in the minutes (page 358) Dr Alruby said “I am more knowledgeable than anybody else in the Practice”.

Both parties confirmed that their positions remained the same and that the issue is whether the current conditions should be maintained or whether there should be no conditions (neither party contended for different conditions).

The National Health Service (Performers Lists) (England) Regulations 2013 should be read in conjunction with this decision and we do not set out full quotations within this decision.

Regulation 10 provides that conditions for the purpose of preventing prejudice to the efficiency of services may be imposed.

We bear in mind cases such as Dr H v NHS England [2023] UKUT 18, East Lancs PCT v Pawar [2009] EWHC 3762 and the FtT decision in Dr Rahman v NHSE [2024] 01075.PHL. “Efficiency” refers to competence and quality of performance and can include concerns regarding probity, credibility and insight. Decisions of the GMC as to fitness to practice do not determine matters relating to the PL and prejudice to efficiency is wider than fitness to practice.

In general terms we must act reasonably, fairly and proportionately.

Prior to summarising central parts of the evidence, we note the Scott Schedule. In summary all the issues remain in dispute.

The statement of Mrs Hazell (page 283 onwards) and its exhibits (together with the appendices to the April 2025 decision letter) give a history of events and proceedings from 2021 onwards. It contains no comment or clinical opinion but expressly states that she is employed in a non-clinical role and her evidence relates to processes and case management. A brief summary (not fully comprehensive) is given in the “Background” above but the statement should be read in conjunction with this decision.

Having affirmed the truth of her statement Mrs Hazell was questioned by Dr Alruby. He asked about a transcript of the April 2025 hearing and she said that the minutes have been provided. She disputed that NHSE was a “proxy” to the GMC and stated that NHSE is independent. In answer to the panel asking whether he challenged the accuracy of the minutes (and if so he should question Mrs Hazell upon that), Dr Alruby said that the conclusion was wrong and he made various references to the GMC and suggested that the IOP had confirmed that he had caused no harm. He said he had no further questions of Mrs Hazell. At a later stage and in response to panel questions, Mrs Hazell said that similar conditions are not uncommon and that there had not been any failures to find employment for practitioners with such conditions (or even with more restrictive conditions). These conditions are at the “light” end of the range of conditions imposed in cases. Conditions are normally reviewed at least every 6 months and there is continuing contact with practitioners so that if the conditions can be removed they are removed. Occupational health assessments involve no cost to the practitioner.

Mr Riggs affirmed the truth of his statement, which should be read in conjunction with this summary. We note the references to induction and support. The system in relation to cataracts was not fully accessed because of lack of DBS and child safeguarding certificates but the work could be carried out albeit Specsavers would not be paid by the NHS. There are then references to supervision and reports. He explained that the records reviewed were chosen entirely randomly and generated by the Specsavers IT system/software. He confirmed that he completed both the NHS report form and also his own summary report which gave greater context (page 179 and page 169 for January 2025, and similarly for February). In the NHS report forms for both months the same 5 areas of History and Examination, Clinical Management, Record Keeping, Consultation and Communication skills, and Understanding the Importance of Appropriate Prescribing were judged as “Needs Further Development”. His summary reports gave further detail and also summarised discussions and advice to address areas of concern. He said that induction involved more time than typically needed for new employees. Typically new employees would satisfactorily complete induction and training within 3 months : Dr Alruby resigned before the 3 month review but Mr Riggs was considering extending the period of probation. Dr Alruby was “clearly struggling” especially with the computer systems but Mr Riggs was happy to support him. He felt that there had been a “slight improvement” but the position was largely the same as at the time of the February review. In relation to shortcomings as to the detail within records, he gave his opinion (as given to Dr Alruby) that “if it is not written down, it didn’t happen” which was not reflected in Dr Alruby’s records.

Dr Alruby then asked questions of Mr Riggs. Mr Riggs agreed that he could be allocated to any of the 5 testing rooms, but that the computer systems are the same in all rooms (and more or less the same as when Dr Alruby previously worked at Specsavers) and that the equipment is more or less the same save for use of a keyboard or a mouse. Dr Alruby was never able to get fully on board the “Opera” system for cataract referrals but this did not prevent appropriate treatment (as opposed to payment). Following Dr Alruby’s unfamiliarity with the range of contact lenses, this was discussed. Mr Riggs was made aware of the incident when Dr Alruby fell asleep during a consultation (“dozed off” in his words) and he referred to the summary at page 176/7, which includes a polite refusal of an offer of time off. It was at this point that it was made known that Dr Alruby had not opened and read the bundle.

On more than one occasion we advised Dr Alruby that he should question Mr Riggs upon any matter with which he disagreed or which he thought not true. After the break to allow the opening of the bundle, Mr Riggs confirmed that he did not have significant concerns that Dr Alruby had endangered patients. Dr Alruby had no further questions he wished to put.

In answer to panel questions Mr Riggs said that he did not find the role of supervisor and being onsite for 50% of the time unduly onerous and that he was onsite most of the time. There had been slight improvement in record-keeping but room for further improvement. The amount of support needed with IT was more than needed by others but he was aware of his age. The NHS report forms were signed by Dr Alruby as well as himself. The summary reports were not but he confirmed it was contemporary record of what occurred and was discussed. It was written as a support for Dr Alruby. He was surprised by his resignation, had not seen any dissatisfaction, and although it was clear he was struggling Mr Riggs gave him support. He had offered an increase from 25 minutes per consultation (as for all others) to 30 minutes but that was politely declined. The time Mr Riggs spent with Dr Alruby was far beyond what was needed by other locum colleagues in respect of induction.

In response to questions as to inadequate records, examples were noted at page 422/3 where advice given was “update” and gave no context or information for a future clinician; and at page 405/6 where reason for visit was stated “DV worse” without any history or context such as with or without glasses, one eye or both, sudden onset, double vision or floaters. It is necessary to ask questions outside of what the patient volunteers and the PVQ (completed by the patient before the consultation) is useful and referred to in the summary reports. In response to Dr Alruby Mr Riggs again confirmed that he was trying to support him when for example offering additional time for consultations.

Dr Alruby gave very short evidence before being questioned. He thought he did not cause any genuine harm to any patient. He believed that the GMC (ie the IOP) had found no evidence to support the allegations relating to the 2 hospital jobs and that the Harlow allegations arose from a bad relationship with the consultant there and that the Birmingham contract was ended because they were requesting more investigations. Mr Riggs was nice to work with but staying in the Isle of Wight was not necessarily productive in his case but he left on good terms. He explained that following earlier treatment he had a need to go the bathroom frequently, that he suffered a severe viral infection, severe diarrhoea, and disturbed sleep and that accounted for the reason he “dozed off” during the consultation.

Mr Cassells then asked questions. He initially asked about the conditions. The first relates to a maximum of 2 practices and he suggested that if there were problems in using 5 different rooms in the same practice there would be even greater problems if there were more than 2 different practices. Having said that if he had been consistently given the same room he would have mastered everything “in 2 or 3 days”, he disagreed that there would be more difficulties if there more practices. As to an induction he said that the induction at Specsavers was not as good as might be and was “patchy” (not having suggested that to Mr Riggs). He did not accept that induction was required, and said it (or having any conditions) was restrictive in terms of finding another employment. Having referred to his health issues, he was asked why it was not reasonable to have a health assessment. He said that it was the wrong attitude and that his condition had never stopped him working. Having been referred to the incident of falling asleep during consultation, he suggested that he did not shy away from being assessed. He was asked whether supervision and instruction were necessary simply because of having not worked in optometry for 4 years and said that he would be “good to go” within 3 days of being in a practice, and did not change such opinion when reminded of Mr Riggs evidence even after 3 months. He said that finding a new practice was difficult with supervision and conditions but accepted that he had not made any applications. In relation to audit, he said that he would arrange it with a company he knows.

He was asked why he did not supply a copy of the expert report obtained from the GMC despite the requirement to provide all correspondence and updates and despite specific request. He said that at this stage he did not think it of any importance and when referred to his agreement he did not accept it was breached. He judged that it was not relevant to NHSE, and anyway he thought that the GMC and NHSE were in communication with each other. When asked if he accepted that he had a professional obligation to comply with current conditions, he agreed but said that he had not been dishonest. When asked about unresolved concerns in 2022, at the hospitals and most recently areas needing further development at Specsavers, he replied that it doesn’t mean anything unless specific and that these were vague. He didn’t accept that he thought only he could decide whether concerns were well-founded and not others. In relation to 2021/2 and glaucoma referrals, he responded that he had worked as a specialist and was better informed as to when referral was required. In relation to Harlow he said that the allegations were malicious. In relation to Birmingham he said he “would stick to my guns” on what was required. In relation to Newport Specsavers he said that he would work in an environment in which he felt safe. When it was suggested that he had provided nothing reflective or undertaken any training, he said he could only do that when integrated into a system and he had been axed from the system. He then referred to his application to the High Court to overturn the decisions of both the GMC and NHSE.

The panel asked questions. He did not think that Mr Riggs’ supervision could help and that there were no clinical issues but only technical/computer issues. He said that he adopted all the 9 points following the review in January (pages 171/2), although we note the same issues are repeated in February. By reference to the record at GR04 (page 418-424) and the lack of any recorded reasoning leading to the prescribing of prism he said that he did not write everything down but only what he thought important. He was asked whether he read the General Optical Council and College of Optometrists guides, and he said “No, I am a doctor”. He was asked about the Personal Development Plan written with Mr Riggs and he said that medicine is practical not theoretical and that he had done nothing to keep up to date because of the time taken up with his court cases and “trying to get my licence back”. He said that he had agreed the conditions in November 2024 under duress to mitigate loss and return to work. He confirmed he had made no job applications and said that he didn’t need to give evidence to show difficulty in getting a job with conditions in force. He said that were lots of problems in being supervised and “I’ve been doing the job for a long time. Optics is superficial compared with ophthalmology”.

Mr Cassells addressed us. We have listened to all his arguments and the various examples he gave, but the essence is that Dr Alruby has no insight, does not reflect, and that “he knows best” is his guiding mantra. He rejects criticism and ignores any opinion or suggestion with which he disagrees.

De Alruby did not address any of the individual issues raised by NHSE. He principally referred to the GMC and his wish to clear his name.

This is a rehearing upon the merits of the evidence before us. As explained to Dr Alruby at the beginning of the hearing we can order that there be no conditions, that there should be different conditions, that the current conditions continue, or that Dr Alruby is removed from the PL – ie any decision which the PDLP could have made.

This is an expert tribunal which is entitled to use its experience and expertise.

Emails have continued to be received from Dr Alruby after the hearing up to and including on 27.11.25. They are a mixture of further suggestions of adjournment/postponement and submissions. The former do not refer to any fresh events or issues not known about at the time of hearing. The latter are largely related to suggested procedure and/or suggested unfairness which also do not relate to anything occurring after the hearing. There is also a suggestion of his being unaware until the last minute that the hearing was taking place on 11^th and 12^th November. There is no explanation as to why matters were not raised earlier before or at the hearing.

We refer to paragraphs 5 and 6 of this decision. We do not consider adjournment is

The further submissions are mostly related to procedural issues and not the substantive concerns on which the Respondent relies. There is no explanation as to why further submissions should be allowed after the hearing had ended. We have rejected the suggestion that he was not aware of the hearing date. Having indicated at the beginning of the hearing that the hearing should continue (see paragraph 6), he again expressly indicated that the hearing should continue without any further short adjournment after he had received assistance to open the bundle. He had already seen many of the documents, which were available to him prior to the bundle being prepared. In any event there is minimal reference in the further submissions to the substance of the concerns on which the Respondent relies.

On more than one occasion the panel advised Dr Alruby that he should challenge any evidence (particularly that of Mr Riggs) with which he disagreed, but his questions of Mr Riggs were very brief (see paragraphs 24 and 25 above). His own evidence was also very brief.

We were impressed by the evidence of Mr Riggs whom we found to be a reliable and consistent witness who was more than willing to support Dr Alruby in his practice. During the hearing Dr Alruby never suggested to the contrary. Mr Riggs’ contemporary records of reviews are clear and are balanced and reasoned. He found areas needing further development and which had not greatly improved over the period of approximately 3 months when Dr Alruby worked at his practice. He was willing to continue to employ him and extend the probationary period despite the concerns he explained. We accept Mr Riggs as an honest and accurate witness both as to facts and as to his professional judgment of areas of clinical practice which were of concern.

There was no real challenge to the evidence of Mrs Hazell, but we confirm that we accept her evidence.

In our judgment NHSE is justified in responding to concerns raised as to the standards of clinical practice and the more so when several concerns in different environments are raised. They have a duty to prevent prejudice to the efficiency of services, including clinical competence and quality of practice and insight.

In 2022 concerns were raised as to glaucoma referrals when Dr Alruby was working for Specsavers in New Milton. He appears to consider that his referrals were appropriate but he voluntarily left the PL before further investigation. Concerns were raised by both hospitals where he then worked, which are the subject of continuing investigation by the GMC. We do not have sight of expert evidence obtained by the GMC and Dr Alruby has not disclosed it either to us or NHSE despite the current condition requiring him to update NHSE regarding the GMC case and provide all correspondence. He left each employment prior to resolution of the disputes. He also resigned from Specsavers in Newport despite Mr Riggs being willing to continue to support him in the context of continuing concerns.

There are several areas of Dr Alruby’s own evidence which we find unsatisfactory and demonstrating a lack of appropriate professional insight. That is in the context of our accepting the evidence of Mr Riggs that various areas of practice required further development and that there is evidence supporting his conclusions which amount to justified concern as to clinical competence. Modern practice in optometry requires use of IT as well as adequate clinical records. His contention that he only needs 3 days in a new practice to be “good to go” is totally inconsistent with the problems that continued after 3 months at Specsavers despite the support of Mr Riggs. His refusal to recognise that he currently has to abide by conditions but failed to do so in relation to the GMC demonstrates either a worrying failure to take professional obligations seriously or an equally concerning attitude that he is his own judge as to what is required. His statement that (albeit practising in optometry) he does not consider guidance from the professional optometry bodies because “I am a doctor” is almost breathtaking in its professional arrogance and a cause for concern as to his objectivity. That is allied to his statement that “Optics is superficial compared with ophthalmology”. In similar vein he said during the April 2025 hearing “I am more knowledgeable than anybody else in the Practice”. He did in our judgment fail to engage with the shortcomings in his records when referred to specific examples. He gave no reason for not complying with the current conditions as though he could choose to do so or not, whether as to occupational health or progress and evidence within the GMC proceedings.

By reference to the Scott Schedule : 1, we are satisfied that sufficient (indeed arguably more than sufficient) training and induction were provided under Mr Riggs’ supervision; 2, see 1; 3, the suggestion that 3 months is not sufficient because of a period of illness is not accepted both because illness was not present for the majority of the time but also because Dr Alruby then voluntarily resigned when continued employment was on offer; 4, we accept the evidence and professional judgment of Mr Riggs as to areas requiring further development; 5, we accept that as at the date of resignation there remained areas in which practice did not reach the standard to be reasonably expected of an ophthalmologist; 6, the response of Dr Alruby seems to assume that he is being criticised for being unwell. The true issue is whether he recognised that his health might affect safe practice and we accept that it might, as illustrated by his falling asleep during a consultation; 7, as already outlined above we have concluded that there is a severe lack of insight which amounts to professional arrogance; 8, there is no mitigation because there is no evidence of reflection and training; 9 and 10, see below.

There is in our judgment more than adequate justification for concern as to professional competence which was increased rather than lessened by his evidence during the hearing of this appeal. There is not only a proper basis for concern as to clinical competence but a degree of lack of insight which amounts to professional arrogance. We seriously considered whether removal from the PL was warranted but we have decided that it is reasonable fair and proportionate to impose conditions and that appropriate conditions will prevent prejudice to the efficiency of services and the safety of patients. We received no submissions from Dr AlRuby as to alternative conditions. We consider that the current conditions are reasonable fair proportionate and appropriate.

The appeal is refused and the current conditions shall remain in force.