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

In professional performance proceedings, the regulator must identify the matters relied on and disclose relevant material so that the practitioner can answer them fairly. Although the process is protective and remedial rather than penal, disputed facts may need to be tested in an adversarial hearing. The question is whether, on the evidence as a whole, the standard of professional performance was seriously deficient. Difficulties in teamwork may justify intervention, but the tribunal must assess them in context and avoid treating one troubled workplace relationship as sufficient without reliable evidence of serious deficiency. An appellate court hearing an appeal at large may reassess the evidence and quash an unsupported finding.

The claimant, an anaesthetist, appealed against a Committee on Professional Performance finding that his professional performance had been seriously deficient. The finding rested on alleged inability to work with colleagues and as a team while employed at a military hospital in Cyprus. The Committee imposed conditional registration for 15 months.

The appeal challenged the evidential basis of the finding, the fairness of the proceedings, the adequacy of particulars and disclosure, and alleged bias and procedural defects. The central issue was whether the evidence, viewed in the circumstances of the hospital and the claimant’s working relationships, established serious deficiency in professional performance.

1. Outcome. The appeal was allowed and the Committee’s decision was quashed. The claimant did not seek costs.
2. Statutory and procedural framework. Section 36 A of the Medical Act 1983 concerns seriously deficient professional performance, not serious professional misconduct. The procedure is protective and remedial. It is not a criminal or disciplinary trial, and the criminal standard of proof does not apply. The Committee must decide the relevant primary facts and whether, on the balance of probabilities, the overall standard of performance was seriously deficient.
3. Fairness. Although no formal charge is brought, the practitioner must receive particulars of the matters relied on and disclosure of relevant material. The practitioner must be able to challenge the evidence. The specific witness and evidence provisions in Schedule 3 to the GMC (Professional Performance) Rules Order of Council 1997 qualify the Committee’s general power to receive relevant material. The proceedings therefore contain an important adversarial element despite their protective purpose.
4. Assessment of teamwork. Poor relationships and team-working can affect patient safety and may amount to serious deficiency. The Committee must, however, assess the conduct in its factual and institutional context. It should allow for conflict, unreliable or hearsay evidence, the conduct of other staff and the possibility that the practitioner was not wholly responsible. The evidence must establish serious deficiency, rather than merely showing that the practitioner was difficult or imperfect.
5. Application. The evidence showed deficiencies in the claimant’s manner and flexibility, but the breakdown in relations was not wholly his fault. Complaints had been exaggerated, key evidence was untested or unsupported, and there was little reliable evidence of a general pattern beyond the particular hospital. Patient risk was largely unsubstantiated, with only one incident potentially involving inappropriate management. The evidence did not justify the finding of serious deficiency.

The judgment does not state a prior judicial decision. The claim was an appeal to the Administrative Court against a decision of the General Medical Council’s Committee on Professional Performance dated 29 October 2004. The appeal was allowed and that decision was quashed.