Abdul Kamara v The NHS Commissioning Board

Ms Susan Greenwood

Mr Abdul Kamara

This is an appeal by Mr Kamara (the Appellant), a dentist, against a decision made by the Performers List Decision Panel (PLDP) on 26 November 2024 and notified to Mr Kamara on 28 November 2024 to remove the Appellant from the National Dental Performers List (the List) pursuant to Regulation 14(3)(b) of the National Health Service (Performers Lists) (England) Regulations 2013 (‘the 2013 Regulations’). The Appellant appealed the decision on 20 December 2024.

The Appellant was removed on the ground of efficiency (Regulation 14(3)(b)). The right of appeal is provided under Regulation 17. It is an appeal by way of a rehearing. The Appellant submits that the decision to remove him from the List was disproportionate and the proportionate response would be to impose conditions on his inclusion on the list, which take into account the remediable nature of the concerns, his commitment to improve, the shortage of dentists in England and the investment already made in Mr Kamara to become a qualified, practising dentist.

This was a video hearing. The parties had agreed to a video hearing in case management. There were no significant connectivity issues.

Regulation 10(1) provides:

Regulation 14 provides:

Regulation 15 provides:

Regulation 15 states that the same matters as those listed at Regulation 15(1) and (2) should be considered where the Board is considering whether to remove a Practitioner from a performers list under Regulation 14(3)(b) (an efficiency case).

The appeal is made under Regulation 17(2)(c). Regulation 17(1) provides that the appeal is by way of “redetermination”. Regulation 17(4) provides that on appeal the First-tier Tribunal may make any decision which the Board could have made. Regulation 17(7) provides that the First-tier Tribunal may, following a request from the Practitioner or on its own initiative, review the First-tier Tribunal’s earlier decision. Regulation 17(8) provides that such a review may not be made within the period of one year beginning with the date of the First-tier Tribunal’s last decision on the appeal.

Therefore, we are required to make a de novo or fresh decision. This may be informed by new information or material that was not available to the Respondent at the point when it made its decision. The determination of the appeal includes consideration of the evidence provided by both parties in this appeal and the oral evidence and submissions made at the hearing.

The Respondent bears the burden of proof insofar as any facts are in issue. The standard is the balance of probabilities. The exercise of the discretion under Regulation 14(3) requires a judgment to be made. The Respondent bears the burden of persuasion in this regard.

Mr Kamara qualified as a dentist in 2016 and registered with the General Dental Council (GDC) on 5 July 2026. He began working at [my]dentist, Tavistock Place (Employer 1).

On 21 January 2020. Mr Kamara was referred to the Respondent by Employer 1 in response to a root cause analysis (RCA) completed by Employer 1 after Mr Kamara extracted the wrong tooth. As a result of this, the Performance Advisory Group (PAG) of the Respondent directed a review of the last 20 extractions conducted by Mr Kamara. He was also directed to provide his reflections on the incident, reflections on the British Orthodontic Society extractions risk management guidelines and to complete a course in ‘Human Factors’. A PAG review took place on 12 August 2020 and the PAG had concerns with Mr Kamara’s commitment to professional performance.

At some point in the Autumn of 2020, Mr Kamara transferred to [my]dentist Falmouth Practice. On 17 November 2020, Employer 1 notified the Respondent that it had terminated Mr Kamara’s employment due to patient safety concerns. Employer 1 informed the Respondent that Mr Kamara had not completed an urgent referral for a patient for swelling on the lateral border of their tongue and the patient was referred six months later by their GP. The patient was diagnosed with squamous cell carcinoma (SCC) and received treatment. Employer 1 also indicated that further concerns had been raised with it by other associates following Mr Kamara’s transfer to the Falmouth Practice.

On 18 November 2020, the Respondent imposed an immediate suspension under Regulation 12(1)(a). On 16 December 2020, the General Dental Council (GDC) imposed an interim suspension order for 18 months and as a result, the Respondent imposed a mandatory suspension.

On 9 September 2021, the GDC varied the interim suspension order to interim conditions for the remainder of the interim order period of 18 months. As a result, the Respondent reviewed Mr Kamara’s case and imposed conditions on Mr Kamara’s continued inclusion on the List. Mr Kamara was also referred to NHS Resolution due to the nature of the conditions.

In November 2021, Mr Kamara started working for Bond Street Dental Practice (Employer 2) under close supervision.

On 17 January 2022, NHS Resolution implemented an action plan for Mr Kamara.

On 17 June 2022, the High Court extended the GDC’s interim conditions on Mr Kamara’s registration by nine months (until February 2023).

On 25 July 2022, Employer 2 informed the Respondent that Mr Kamara had been working without indemnity insurance since January 2022 and it had received complaints. As a result, on 27 July 2022, Employer 2 terminated Mr Kamara’s employment.

On 13 September 2022, the PDLP of the Respondent considered Mr Kamara’s explanation for the lack of indemnity insurance and the information from Employer 2 and decided to vary the Appellant’s conditions on his inclusion on the List.

In October 2022, Mr Kamara started working at Kimberley Park Dental Practice (Employer 3), under supervision.

In mid-December 2022, the Respondent received further information from Employer 2 about further concerns with Mr Kamara (raised since it had terminated his employment). The allegation related to a patient being approached by Mr Kamara after treatment to have a non-professional relationship. The patient had also raised concerns about contact from Mr Kamara, after Mr Kamara used the record system of Employer 2 to obtain the patient’s mobile number and make contact on WhatsApp. The patient also raised clinical concerns. Separately, the patient also referred Mr Kamara directly to the Respondent.

On 2 February 2023, Employer 3 contacted the Respondent with concerns about Mr Kamara’s clinical practice, patient safety, professional competence and behaviour. It was reported that Mr Kamara had failed to follow his supervisor’s instructions to make an urgent suspected oral cancer referral for a patient relating to a suspected lesion on the lateral border of the tongue. The referral should have been made, on the supervisor’s direction, following the appointment on 7 December 2022. The referral did not take place until 5 January 2023, following a further, routine appointment for the patient. The patient was diagnosed with squamous cell carcinoma (SCC) and required treatment to remove the SCC.

On 28 March 2023, the PDLP varied Mr Kamara’s conditions, which changed direct supervision to close supervision and imposed further conditions.

In October 2023, Mr Kamara started working for Gentle Dental Falmouth (Employer 4) under supervision.

On 28 February 2024, the PDLP considered the Professional Standards investigation outcome for Mr Kamara regarding Employer 3’s referral. As a result, Mr Kamara was directed to undergo independent reviews of his behaviour and practice. The conditions were varied to reflect the directions.

In October 2024, Mr Kamara started working for Fresh Dental (Employer 5), two days per week, under supervision.

On 9 October 2024, the PDLP considered the directed reports on Mr Kamara and decided to suspend him from the List pursuant to Regulations 12(6) and 12(1)(a), due to risk and consideration of removal.

On 9 November 2024, the GDC imposed an interim suspension order until March 2025.

On 26 November 2024, the PDLP held an oral hearing to consider removal and on 28 November 2024, the outcome letter was sent to Mr Kamara, confirming that the PDLP had decided to impose removal from the List on efficiency grounds.

On 29 January 2025, the GDC’s Interim Orders Committee varied the interim suspension order on Mr Kamara’s registration to interim conditions requiring direct supervision.

During the hearing, Mr Kamara confirmed that in the coming month, he is due to attend and represent himself in a hearing before the Professional Conduct Committee of the GDC, concerning the matters set out at paragraph 22 above.

Mr Kamara applied to the Tribunal to admit late evidence, in the form of a six-page document of written submissions, which he had drafted when preparing for the hearing. Mr Cridland raised no objection, noting that Mr Kamara was representing himself in the proceedings. The Tribunal reviewed the document and decided it was just and proportionate to admit it. In effect, it set out Mr Karma’s key points for wishing to remain on the List, with conditions. It did not raise any new points, beyond the personal impact removal from the List would have on Mr Kamara and his family. The Tribunal concluded it was relevant to the issues in the appeal. The document was duly admitted.

Mr Green, Specialist Member of the Tribunal, informed the parties that he had known three dentists who have provided references relating to Mr Kamara, namely Mr Adam Randall, Ms Carolyn Bradburn and Mr Clive Pidgeon. Mr Green confirmed that he had last had professional contact with each of them more than14 years ago and that was the extent of his contact. Both parties were invited to consider the information and indicate to the Tribunal if they raised any objection to Mr Green continuing to hear the appeal. Neither party raised an objection.

We considered the core issues to be:

The Tribunal had in evidence before it a main hearing bundle consisting of 372 digital pages of documentary evidence which included the appeal, response and directions made prior to the final hearing, the parties’ initial evidence, witness statements, the 2013 Regulations and the decisions of the PDLP, including the one subject to appeal, notified on 28 November 2024. Both parties also prepared helpful skeleton arguments, in addition to Mr Kamara’s six-page document entitled ‘Argument for Reinstatement’, which he provided on the morning of the hearing.

The hearing was recorded by the Tribunal administration. The Tribunal does not intend to set out a summary of the oral evidence from Ms Greenwood and Mr Kamara. We have referred to evidence, as is necessary, in our findings and conclusions.

Mr Kamara accepted that he required some form of conditions in place as there had been issues with his clinical practice in the past. He explained that he was presently subject to interim conditions on his registration with the GDC, which require direct supervision at all times in his clinical practice from an approved workplace supervisor. He also indicated that he wished to challenge that condition by way of an early review of the conditions. Mr Kamara submitted that a proportionate response to the issues raised in the past would be to impose conditions on his continued inclusion on the List, to amount to three days of close supervision per week, one day of direct supervision and one day of shadowing, to be provided by Mr Azud Irshad, the principal (and only other) dentist practising from Fresh Dental.

The Respondent submits that due to the serious and wide-ranging nature of the past concerns with Mr Kamara’s practice, it is necessary and appropriate to remove him from the List as his continued inclusion on it is no longer efficient to the delivery of NHS primary dental services. The Respondent does not consider the issues to be remediable, given that they have been ongoing for a period of approximately five years. The Respondent contends that the only viable condition would be for Mr Kamara to be subject to direct supervision at all times in his clinical practice, which would be inefficient as it would mean assigning two dentists to the clinical work of one dentist.

We have considered all the evidence and submissions which were before us. If we do not refer to particular parts of the evidence or submissions in our reasoning, it should not be assumed that we have not considered them.

As a result of a number of concerns raised by employers, the Respondent’s Performance Advisory Group (PAG) and Performers List Decision Panel (PDLP) had cause to impose actions and, eventually, conditions on his inclusion on the List. There was little dispute from Mr Kamara as to the fact of the incidents having occurred. At various points, Mr Kamara wished to stress the need for context and his explanation as to why it would not happen again if he were allowed to return to practice in the NHS.

There were two significant clinical incidents, which occurred within the space of 10 months. On 23 May 2019, Mr Kamara extracted the wrong tooth (the UR4, as opposed to UR5). He was referred to the Respondent on 21 January 2020, after a root cause analysis had determined that the wrong tooth was extracted due to human error. The PAG determined that Mr Kamara could address the failure by undertaking remediation and through support from his employer.

On 16 March 2020, Mr Kamara had seen a patient for swelling of the lateral border of the tongue. He completed a referral, but he failed to send it. Six months later, in October 2020, the patient was seen by their GP and subsequently diagnosed with SCC. The Tribunal noted that as a result of this incident, Mr Kamara was placed on a service level improvement plan by his employer and was not meeting requirements, from the employer’s perspective. This was an employer dealing with two clinical incidents in the space of three months.

The employer suspended Mr Kamara and by 17 November 2020, his contract was terminated. At this point, the employer had also raised concerns about complaints from a dentist who had taken over from Mr Kamara at the Tavistock Practice of the employer, regarding Mr Kamara’s failures to diagnose or take radiographs for a patient with dental caries and a failure to implement a treatment plan, as well as a failure to diagnose and treat a patient with periodontal disease.

On 18 November 2020, the Respondent suspended Mr Kamara due to the two concerns in January 2020 and March 2022. The Tribunal notes this as it demonstrates the Respondent taking more restrictive and responsive action, as a second serious clinical incident was shared with it within the space of six months. In the Tribunal’s view, the actions of the Respondent, in response to the two incidents and the decision to suspend from the List was a proportionate response. In any event, the GDC imposed an interim suspension order on 16 December 2020. Similarly, after the GDC varied the interim suspension order to interim conditions, on 16 September 2021, in October 2021, the PDLP imposed conditions on Mr Kamara’s continued inclusion on the List. Following an investigation of the clinical issues, the PDLP imposed conditions on continued inclusion on the List, which were agreed by Mr Kamara on 14 October 2021. The conditions included a condition of close supervision from a workplace supervisor. It was accepted by Mr Kamara, at that point, he required remediation of his clinical practice through a period of complying with conditions.

Mr Kamara secured employment with Bond Street Dental Practice (GenSmile) in Falmouth. His supervisor was approved by the Respondent and an action plan was implemented from January 2022 onwards. At a review meeting with Mr Kamara’s supervisor, held in April 2022, it was noted by Mr Kamara’s supervisor that he was working hard towards becoming a safe practitioner. This history of intervention from the Respondent and Mr Kamara’s response was clearly set out in the documentary evidence and the two witness statements from Ms Greenwood. The Tribunal concluded that by the point of April 2022, Mr Kamara appeared to be making progress towards meeting the conditions imposed by the Respondent.

However, at a point when there had not been full remediation of the clinical issues, his employment was terminated on or around 25 July 2022 as he was found to have been practising without indemnity insurance, from January 2022 onwards. Mr Kamara appeared, at that time, to accept his professional responsibility for ensuring he had indemnity insurance in place. He managed to secure a new employer, Kimberley Park Dental Practice, under which he would continue the Respondent’s action plan. He started working there in October 2022 and by 1 December 2022, the employer had raised a complaint received from a patient – with the Respondent. This complaint concerned a patient reporting that Mr Kamara had filled a tooth without clinical justification.

On 2 February 2023, Mr Kamara’s supervisor contacted the Respondent to raise a concern with Mr Kamara’s clinical practice. The supervisor reported that on 7 December 2022, whilst working under supervision, Mr Kamara saw a patient with a suspicious and painful lesion on the lateral border of their tongue. The supervisor provided advice to Mr Kamara, that he should refer the patient immediately under the NHS urgent 2 week wait oral cancer pathway for suspected oral cancer. The supervisor reported that on 8 December 2022 he checked with Mr Kamara on the referral and Mr Kamara was completing a form for a routine referral. The supervisor reported that he indicated to Mr Kamara of the need to complete the urgent 2 week wait referral form. Mr Kamara did not do this and decided to wait to see the patient in four weeks’ time. The patient was reviewed by Mr Kamara on 3 January 2023 and two days after the review, MR Kamara completed a referral. On 31 January 2023, the patient complained to the employer as the maxilla-facial consultant questioned the delay in the referral. The patient was diagnosed with a SCC and required surgery to remove the lesion.

The PDLP held an oral hearing on 28 March 2023, which Mr Kamara did not attend. The conditions had been varied to direct supervision. As a result of the 28 March 2023 hearing, which considered Mr Kamara’s submissions on conditions which did not impose direct supervision, the conditions were varied to include close supervision with additional safeguards and requirements on Mr Kamara. At this stage, it is clear to the Tribunal that Mr Kamara was still not able to practise safely and competently. Therefore, the decision to impose more robust conditions on his continued inclusion on the List was proportionate. The Tribunal had no doubt that from May 2019 until March 2023, for almost four years, Mr Kamara had been unable to assure the Respondent that he could practise safely and competently.

By October 2023, Mr Kamara commenced work at Gentle Dental Falmouth for two days per week, working under the conditions from the Respondent. On 28 February 2024, the PDLP considered the outcome of an investigation conducted by the Professional Standards team of the Respondent relating to the incidents reported by Kimberley Park Dental Practice and Bond Street Dental Practice. The PDLP determined that Mr Kamara should undergo independent reviews of his clinical practice and his behaviour.

The behaviour report was provided on a date after 18 June 2024 and the clinical performance report was provided to the Respondent on 3 October 2024. The clinical performance report was carried out by two clinical assessors, both dentists. They observed all 13 of his consultations on one day, conducted a review of 20 records randomly select from 50 records which were representative of Mr Kamara’s practice, and they selected 12 cases from the records and the consultations. For each case, they asked Mr Kamara three questions regarding reasoning and clinical decision-making. The assessors concluded that Mr Kamara was practising below the level reasonably expected of a general dentist practitioner. They found his performance inconsistent in the areas of patient assessment, clinical management, operative and technical skills and record keeping. They found his practice satisfactory in the areas of infection control, communication and practitioner-patient partnership, seeking consent and working with colleagues. They found his practice poor in use of resources and maintain professional performance. Crucially, the report recommended that if further remediation was deemed appropriate, a deeper level of supervision, including observed consultations, would be required.

Therefore, by the point of the hearing on 26 November 2024, it was accepted that Mr Kamara had been subject to conditions since 2022 and an independent clinical performance report had identified the need for a further enhancement of supervision.

The Tribunal concluded that there was sufficient evidence presented by the Respondent as to one other relevant concern in Mr Kamara’s practice. Mr Kamara accepted, on his own account, that he had attempted to strike up a meeting with a female patient, after providing dental treatment to her. He accepted that he had spoken to her in a room, with just the two of them present. He also accepted that he had contacted her after the event, having secured her mobile telephone number from the records held at the dental practice – records held for the sole purpose of contacting patients for dental treatment. Mr Kamara explained that this had been a lapse in judgment, and he had simply wished to speak with the female patient about difficulties his then partner’s son was having at school. He insisted that he had asked the patient for her mobile telephone number, and she had agreed to give it to him and he then indicated that he could simply obtain it from the records at the dental practice. This is not how the patient has reported that matter – she indicated that she did not provide her consent to access her records to obtain her mobile telephone number. Furthermore, she has reported that the incident made her feel uncomfortable and she felt under pressure to say yes to meeting in a pub. The way this incident made the patient feel crystallises how important it is to maintain professional boundaries. Even on Mr Kamara’s account, he accepts that his decision-making was not appropriate.

The Tribunal found that there was sufficient evidence before it to engage the efficiency ground, at the date when the decision was made by the PDLP on 26 November 2024. From 2022 onwards, Mr Kamara had been continuously subject to either conditions on his continued inclusion on the List or suspension from the List due to ongoing issues with his clinical performance. By the point of the PDLP hearing, he had been unable to demonstrate consistent safe practice as a dentist.

Mr Kamara gave detailed oral evidence. A constant theme of his oral evidence was his limited acceptance of professional accountability in the previous failures in his practice. The Tribunal considered that Mr Kamara sought to minimise the seriousness of past actions or inactions by seeking to ‘contextualise’ it. In the Tribunal’s view, Mr Kamar’s contextualisation of the incidents was a means of seeking to allocate responsibility to others and to minimise the significance of his role. This led the Tribunal to conclude that Mr Kamara finds it difficult to accept professional accountability and it did not persuade the Tribunal that he has undertaken a level of professional and personal reflection which would be required to embed any remediation of his clinical practice.

As an example of this, he criticised the methodology of the clinical performance assessment, having accepted the findings overall, as he said in oral evidence. This was the first time he advanced this argument about a flawed methodology. He criticised the decision of the assessors to observe him seeing adult patients. However, the reality was that the assessors had no influence over his consultation list on the date in question. They observed the 13 consultations which had been booked into his diary for that day. Mr Kamara also considered the report flawed as the assessors referred to out of date practice on the grading of radiographs. The Tribunal did not consider that either of these criticisms actually undermined the substance of the report and its findings.

He also made the point that the assessors would have found fault with any dentist they observed or reviewed. In the Tribunal’s view, this comment failed to appreciate the significance of the restrictions and interventions put in place by PAG and the PDLP, in a context where the PDLP required the clinical performance review as it had concluded that Mr Kamara’s clinical knowledge was not the issue, but his practical application of skills. Furthermore, the decision to direct such a clinical performance assessment came in response to an investigation which established that Mr Kamara had practised without indemnity insurance for a period of six months and a second incident of failing to refer a patient for suspected oral cancer, on an urgent basis. The Tribunal considered Mr Kamara’s attitude towards the clinical performance assessment, and its outcomes supported the conclusion that he has not used the clinical performance assessment findings to inform deeper reflection and remediation.

As a further example, Mr Kamara explained that he wished to strike up a networking or mentoring relationship with a patient. Mr Kamara explained that he did recognise at the time that his actions may make the patient feel uncomfortable, so that was why he asked for permission to review her confidential patient records to obtain her telephone number. He also explained that his decision to take along a colleague as a chaperone to the meeting in a pub was because he thought it might seem a bit weird to hold the meeting one to one. At the same time, he also stated that he was acting on impulse and that he did know that it was inappropriate to ask the patient into a private room with just him, in order to arrange a meeting. He explained that ‘there is a difference between knowing and doing’, that it was an error from stress and that he did not question himself. The Tribunal found this explanation concerning – in that he seemed to understand that all of his actions were not acceptable, at the time, and yet he proceeded to carry them out, with little to no regard for the likely impact on the patient. It was significant that during oral evidence, the part of his behaviour that he thought may have made the patient feel uncomfortable would have been taking her number without permission, which is why he asked for permission. This account is at odds with the account from the patient. The Tribunal considered the reflection on this incident was limited from Mr Kamara if, as of today, he is unable to appreciate the professional boundaries that were crossed, even on his own account.

As to the extraction of the wrong tooth, Mr Kamara made the point that the affected patient cannot understand why such severe actions have been taken against Mr Kamar’s practice as a result. This observation from Mr Kamara belies Mr Kamara’s understanding of the seriousness of a never event such as that.

As to the second incident of a failure to make an urgent referral for suspected oral cancer, Mr Kamara stated that he had reflected on the incident, but he did not accept that he should have made a referral on 7 or 8 December 2022. He seemed to accept that he should have given serious consideration to making an urgent referral, but the patient did not present with any red flags. On reflection, it was his view that the failure to refer was not serious and that his supervisor did not advise him to make an urgent referral on 7 and again on 8 December 2022. The Tribunal notes that Mr Kamara’s supervisor contacted the Respondent directly to report his concerns that Mr Kamara has not acted on his instructions. This happened in a context where Mr Kamara was subject to supervision as part of conditions on his continued inclusion on the List. In any event, on Mr Kamara’s account, even if his supervisor had advised him to complete an urgent referral on both 7 and 8 December 2022, Mr Kamara would not have done so as he did not consider there was any clinical need for it at that point. This runs counter to the investigation report from the Respondent and the conclusions of the PDLP at its review meeting on 28 February 2023. From the Tribunal’s perspective, it demonstrates an entrenched view from Mr Kamara that he did not fail in any respect in his clinical judgment for the patient. This supports the picture that clearly developed during Mr Kamara’s oral evidence of limited insight into the significance of past clinical and other incidents, which led the Tribunal to conclude that it is likely to be difficult for Mr Kamara to remediate his practice.

Mr Kamara accepted that there was a need for some form of conditions on his continued inclusion on the List. He indicated that he would leave the formulation of the specific conditions to the Tribunal. He did not accept that he requires direct supervision, not least as he plans to challenge that condition, which is part of the interim conditions imposed by the Interim Orders Committee of the GDC. He presented a proposal to the Tribunal of three days of close supervision per week, one day of direct supervision and one day of shadowing. This is indicative of Mr Kamara’s view of his practice at the present time and his assessment of the past incidents – he does not consider there is a need for direct supervision. Ultimately, the Tribunal did not agree with his assessment.

The Tribunal carefully assessed the evidence from Mr Kamara. He is currently undertaking one day of working on private patients under the direct supervision of Mr Irshad and has been since 14 February 2025. Presently, Mr Irshad is the only other dentist working at the practice. Mr Kamara submitted three supervision documents to the Tribunal to assist us in understanding the remediation he has completed since starting to work under Mr Irshad’s supervision. Mr Irshad also provided a report to the GDC dated 30 April 2025 and an undated letter in which he confirmed that he would be happy to provide Mr Kamara with one day of shadowing, one day of direct supervision and three days of close supervision. This letter must predate 29 January 2025, as it refers to suspension by the GDC and the interim suspension order was varied to interim conditions on 29 January 2025. Mr Kamara is presently under 12 interim conditions, including a conditions of direct supervision at all times whilst providing dental services from a workplace supervisor approved by the GDC.

Mr Kamara provided other documents to support his position on remediation, including three references from fellow dentists who have known him for some time and three direct observations of procedure dated 7 March 2025, 28 February 2025 and 21 February 2025. There is also a direct observation of procedure for eight bitewing radiographs (on four patients) and 17 periapical radiographs (on three patients). The Tribunal notes that Mr Irshad signed them all on 6 May 2025. It was not clear why there had been a delay in Mr Irshad signing the documents. These documents were of some assistance to the Tribunal, but it would have been helpful to have a larger number and wider range of them. Furthermore, it would have been extremely helpful to the Tribunal to have a recent and detailed supervisor report from Mr Irshad or to have heard from him at the hearing. The Tribunal placed weight on the remediation documents from Mr Kamara and considered them with care.

In light of our findings, we must now consider whether because of the incidents in the past and in light of what Mr Kamara has done since the decision to remove him was made on 26 November 2024, it remains proportionate to remove Mr Kamara from the List on the ground of efficiency.

The Tribunal concluded that due to the past wide-ranging issues with Mr Kamara’s clinical performance and the depth of the actions taken by the Respondent and Mr Kamara to seek to address them, over a very lengthy period of time, it would not be appropriate for anything less than restrictive conditions to be imposed on Mr Kamara’s continued inclusion on the List.

The next consideration became the proportionality of imposing conditions, short of removal from the List, taking into account the length of time conditions had been in place for Mr Kamara and the nature of the conditions required to meet the ongoing risk to patient safety. In the circumstances of this case, the Tribunal concluded that Mr Kamara would require, at the very least, direct supervision of all of his clinical practice, if he were to remain included on the List to provide primary dental care in NHS services. The Tribunal took into account that he is currently required to have direct supervision in place at all times as part of the interim conditions on his registration. Given the serious nature of the past incidents and the ongoing concerns about his clinical performance, direct supervision at all times remains necessary.

The Tribunal took into account the ongoing impact on Mr Kamara who qualified as a dentist against considerable obstacles in his education and in experiences in his personal life. The Tribunal commends Mr Kamara for his work and his dedication, but this does not take away from the requirement to consider the impact on Mr Kamara against the history of concerns, the serious nature of them, the limited insight, the ongoing issues of clinical performance and associated risk to patient safety.

Our consideration of proportionality does not end there. The one ground on which the Respondent relies for removal is that of efficiency. In our consideration of the efficiency ground, which, as we have already indicated, we conclude remains engaged, we must consider matters set out at Regulation 15(5) and (6). We note that Mr Kamara has been subject to conditions since 2022 and has been unable to demonstrate safe and effective practice on a consistent basis since then. We also take into account what it is about Mr Kamara’s continued inclusion on the List which would be prejudicial to the efficiency of the services which those included in that List perform. In a context where there is a national shortage of dentists providing NHS services, if Mr Kamara were to remain on the List, any conditions would necessitate direct supervision at all times, which would mean two dentists providing NHS services instead of one. In the Tribunal’s view, it is clear that Mr Kamara’s continued inclusion on the List would prejudice the efficient delivery of primary dental care in NHS services.

It follows that the decision to remove Mr Kamara from the List is proportionate.