Mohit, R (on the application of) v The General Medical Council

An appellate court reviewing a Fitness to Practise decision will not intervene merely because it might have reached a different conclusion. Intervention requires the decision to be clearly wrong, particularly where the specialist tribunal has relevant expertise. Patient protection extends beyond clinical competence. Deficiencies in communication, professional relationships and insight may create a risk to patients. A tribunal may therefore consider whether the doctor recognises the deficiencies, has undertaken relevant remedial education and has shown a realistic prospect of improvement. It must balance patient protection, the public interest and the doctor’s interests, and impose a proportionate sanction.

The claimant, a doctor whose registration had previously been suspended for deficiencies in professional performance, was granted six months of conditional registration. The conditions restricted him to an educationally approved senior house officer or locum post, under approved supervision and within one deanery.

He did not obtain a suitable post during that period. On review in December 2004, the Fitness to Practise Committee concluded that he had not sufficiently addressed the identified deficiencies, particularly his attitudinal problems and lack of insight, and that further conditions offered insufficient protection. It imposed a further 12-month suspension. The claimant appealed, seeking additional time to obtain hospital employment.

1. Appeal dismissed. The court applied the established approach to appeals from specialist Fitness to Practise bodies: it would not interfere unless the decision was clearly wrong. The Committee’s specialist expertise was an important consideration.
2. The Committee was entitled, and required, to consider protection of patients and the public interest. The absence of disputed clinical deficiencies did not remove the potential risk. Poor communication with patients, deficient relationships with colleagues and attitudinal problems could create danger, particularly in pressured clinical settings.
3. The Committee was entitled to treat insight as material. The claimant’s continuing refusal to accept deficiencies previously established by the regulatory process could indicate a lack of insight and a consequent risk that necessary remedial measures would not be taken.
4. The Committee was also entitled to assess the relevance and adequacy of the claimant’s educational activities. General professional development did not sufficiently address the particular communication and attitudinal deficiencies. It was reasonable to consider supervised voluntary work or other practical opportunities as possible ways of testing and improving performance.
5. The Committee had balanced the claimant’s interests against patient protection, the public interest and the interests of the profession. Its conclusion that further conditions offered insufficient protection, while an immediate suspension would be disproportionate, was open to it and was not clearly wrong.

The appeal was dismissed with costs summarily assessed at £2,611.70.

• Fitness to Practise Committee: In June 2004, granted six months’ conditional registration subject to supervised and educationally approved employment conditions.
• Fitness to Practise Committee: On 15 December 2004, imposed a further 12-month suspension after finding insufficient evidence of improvement and inadequate prospects of improvement through further conditions.
• High Court (Administrative Court): Dismissed the appeal and awarded the GMC costs of £2,611.70.