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A hospital doctor will remain under review for a further 18 months after a misconduct tribunal heard steps to address performance failures had not been met.
Dr David Aitchison saw restrictions first imposed in 2016 at a misconduct hearing into his conduct while working in accident and emergency at Darent Valley Hospital in Dartford.
Clinical failings were found proven relating to concerns over his care of four patients falling "well below expected standards" when he worked for Dartford and Gravesham NHS Trust as a middle grade locum doctor.
The tribunal also reviewed his performance at East and North Hertfordshire NHS Trust.
The initial hearing five years ago heard evidence about "less serious clinical failings" relating to the care of 16 patients during a three-month period.
These included poor record keeping, failure to make appropriate diagnosis and failure to refer patients for appropriate tests or scans.
A panel at the Medical Practitioners Tribunal (MPT) found his actions "amounted to misconduct which was serious".
But Dr Aitchison, who qualified in 1978, avoided being struck off from the medical register and saw a range of conditions imposed, including restrictions on his clinical practice.
A review hearing – the third into Dr Aitchison's conduct – held earlier this month found he had not taken sufficient steps to address the concerns and that his fitness to practice remains "impaired".
Zoe Dawson, counsel to the General Medical Council, told the hearing the body felt Dr Aitchison's ability to practice remained impaired due to his previous misconduct.
A report published following the hearing on October 5, MPT panel chairman Nicholas Flanagan said continuing conditions on Dr Aitchison's registration would continue to protect the public adding taking no action would be "neither sufficient, proportionate nor in the public interest".
He said: "The Tribunal carefully considered all the circumstances of the case, but determined that the imposition of a period of suspension would serve no useful purpose and is likely only to have a detrimental effect.
"The Tribunal considered that there was some evidence of Dr Aitchison continuing to develop insight and take steps towards remediation, although these had been interrupted due to a variety of factors.
"The imposition of a period of suspension would serve no useful purpose..."
"The imposition of conditions would further the overriding objective, in particular, ensure that the safety of the public was adequately maintained.
"The Tribunal recognised the insight Dr Aitchison has gained, as he acknowledges he has not undertaken sufficient steps to satisfy the Tribunal that he is no longer impaired.
"However, Dr Aitchison’s level of insight and remediation remains incomplete."
The hearing was told Dr Aitchison had not been able to demonstrate he had developed a suitable personal development plan or keep his responsible officer updated as to his progress.
The panel found Dr Aitchison had completed online learning modules but ruled this had not been sufficient to show enough development to overturn concerns relating to his clinical performance.
Dr Aitchison, who says he plans to retire next May, admitted to the panel he felt his fitness to practice remains impaired.
The report noted the doctor provided "various reasons" for why progress had not been made.
He said while appraisals had been completed he had been "unable to upload it to the relevant system" due to storage issues on his computer account, had difficulties reaching his responsible officer.
The panel was also told Dr Aitchison intends to complete non-clinical duties until his retirement.
Mr Flanagan's report added: "The Tribunal considered that Dr Aitchison has failed to take sufficient steps to remediate the original concerns regarding his fitness to practise.
"The Tribunal considered Dr Aitchison’s submission that he had in fact completed substantial amounts of CPD (Continuing Personal Development).
"However, it remained unsure of the value as there was little evidence of Dr Aitchison reflecting on his learning, which is an integral part of modern CPD.
"The Tribunal was not satisfied that Dr Aitchison understands that completing online modules alone is insufficient.
"The Tribunal therefore found a continued lack of insight and reflection by Dr Aitchison, particularly in the areas of record keeping, safeguarding, and clinical work."
A further review hearing can be held and Dr Aitchison is entitled to appeal the tribunal's ruling.
