Lambiris v Specialist Training Authority of the Medical Royal Colleges

For specialist medical qualifications outside automatic mutual recognition, Article 8 of Directive 93/16/EEC provides a route to the host State’s qualification, rather than automatic recognition of the qualification granted by the State of origin. The host State may require its own training conditions and must assess whether previous training corresponds in content and duration. It may investigate training undertaken in its own territory despite an origin-State certificate. Under the European Specialist Medical Qualifications Order 1995, the specialist authority may assess the form and supervision of training when deciding whether a foreign qualification meets the consultant standard. It need not separately examine the applicant’s abilities. The appeal was dismissed.

Dr Lambiris, a Greek and British national, obtained a Greek specialist qualification in dermatology-venereology after working in United Kingdom hospitals. That specialty was not recognised in the United Kingdom. He sought entry on the specialist register, principally as a dermatologist, under article 9(3)(a) of the European Specialist Medical Qualifications Order 1995, rather than applying for a certificate of completion of specialist training.

The Specialist Training Authority and its Appeal Panel rejected the application. They found that the United Kingdom posts were not recognised supervised training posts and that the evidence of later locum-consultant experience was insufficient. Mr Justice Scott Baker rejected the challenge in the Administrative Court. The central issue on appeal was whether the Authority had failed to give effect to Article 8 of Directive 93/16/EEC.

1. Majority disposition. Buxton LJ delivered the leading judgment and Aldous LJ agreed. The appeal was dismissed with costs, and permission to appeal to the House of Lords was refused.
2. The right of establishment under Article 43 EC is mediated by the relevant directive where a directive provides a specific recognition scheme. It does not create a separate, undefined right enabling an applicant to avoid the host State’s professional requirements. A mobile professional cannot be placed in a better position than a person subject solely to the host State’s rules. The host State must assess the applicant under its own domestic requirements.
3. Where an origin-State certificate concerns training or professional activity carried out in the host State, the host State may examine the underlying reality and matters bearing on the genuineness of that activity. It is not confined to checking the document’s authenticity. This applied particularly because the United Kingdom authorities had direct knowledge of the posts relied on.
4. Article 8 of Directive 93/16/EEC concerns access to the host State’s qualification after any necessary additional training. Article 8(2) requires corresponding training periods to be taken into account, and correspondence is not limited to duration; content is also relevant. The majority considered that Article 8 did not require the Authority to conduct that exercise because Dr Lambiris had pursued the separate domestic route under article 9(3)(a) of the Order. In any event, the evidence showed no relevant specialist training apart from a possible three-month period.
5. Under article 9(3)(a) of the Order, the question was whether the foreign specialist qualification, considered with relevant experience or knowledge, gave the level of knowledge and skill consistent with practice as an NHS consultant. The Authority was entitled to assess the type and supervision of training. The qualification, rather than the applicant through a fresh skills examination, was the object of assessment.
6. The court would not substitute its own view for that of an expert professional body on the nature and intensity of specialist training. Intervention required a conclusion approaching irrationality. Rix LJ dissented on the narrow procedural issue. He considered that Article 8 had been invoked, that the Authority had not directly determined it or identified the training gap, and that the matter should be remitted for a fresh determination.

1. Court of Appeal (Civil Division). Under [2003] EWCA Civ 609, the appeal was dismissed with costs. Permission to appeal to the House of Lords was refused.
2. High Court, Queen’s Bench Division, Administrative Court. Mr Justice Scott Baker rejected Dr Lambiris’s challenge to the Specialist Training Authority’s decision.