An investigation into a botched primary care group election in Birmingham has recommended that future polls should not be handled by health authority officers.

GP Ian Fletcher won a 'secret ballot' by one vote for chair of Ladywood PCG in October.

But supporters of opponent Mushtaque Ahmad spoke up when they spotted two ballot papers carrying the name of a third candidate, who had withdrawn from the election hours before the ballot began.

Following 'heated debate', papers were returned to the box, which was re-sealed. Birmingham health authority locality commissioning manager John Brett took charge of them while HA officials took advice from the Electoral Reform Ballot Service.

Four days later, the seal on the ballot box was found to be broken and a list of voters - including the numbers of their ballot papers - was missing.

An internal investigation was ordered into the election, which had 'aroused a considerable amount of passion', HA secretary Richard Miles said in his report to the board. In November, Dr Fletcher withdrew from the election, leaving Dr Ahmad and two new candidates to take part in fresh elections - run by the ERBS - held last week. Dr Philip Hamilton won by a 'substantial margin'.

The investigation heard that several doctors had been approached by 'as yet unidentified people' and told that it was known how they had voted.

But Mr Miles' report found 'uncertainty' among those questioned as to whether the list of voters, which gave the names of doctors and the numbers of ballot papers issued to them, had been put in the box after the election.

Mr Miles found the sealed ballot box had been tampered with and the seals broken at some point between sealing and reopening for counting.

He concluded that 'no disciplinary procedure should be implemented' against Mr Brett, who seemed 'trustworthy'. But the report recommended that future elections should not be run by the HA as 'the appointment of people to... PCGs is likely to come under formal scrutiny at some point'.