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

In reviewing a professional disciplinary sanction, the court should interfere only where the sanction is clearly wrong. The court must respect the disciplinary panel’s primary responsibility for professional standards and public confidence. Dishonesty by a doctor is exceptionally serious and will ordinarily make erasure a live possibility, even where it concerns private conduct and causes no direct patient harm. Erasure is not automatic, however. The panel must assess the precise nature and seriousness of the conduct, the practitioner’s actual involvement, insight, mitigation and relevant personal and professional circumstances. A mistaken assessment of the seriousness of the conduct may make erasure clearly wrong. In that event, the court may substitute a lesser sanction within the panel’s statutory powers.

The claimant, a general practitioner, had been convicted of four offences under the Criminal Justice Act 1988 involving assistance in retaining or disposing of the proceeds of her daughter’s fraud. She was acquitted of a further count requiring knowledge rather than suspicion. The Fitness to Practise Panel found that her conduct involved dishonesty, seriously departed from professional standards and was fundamentally incompatible with continued registration. It directed erasure from the medical register. The claimant challenged that sanction, relying on her limited involvement, professional record, personal circumstances and the Panel’s assessment of her conduct and insight. The central issue was whether erasure was clearly wrong and, if so, what sanction should replace it.

1. The appeal was allowed. Erasure was replaced by suspension for 12 months, taking effect immediately. There was no order for costs.
2. The court would interfere with the Panel’s sanction only if it was clearly wrong. It must give considerable deference to the Panel, which Parliament had entrusted with setting and applying professional standards. The court should not substitute its own view merely because it might have imposed a different sanction.
3. Dishonesty is one of the most serious forms of professional misconduct. It undermines public trust in the medical profession, even where it arises from a doctor’s private life and causes no direct harm to patients. A conviction involving dishonesty will inevitably require consideration of erasure, but it does not make erasure automatic. The proper sanction depends on the individual case.
4. The Panel had been entitled to conclude that the claimant’s conduct was dishonest and seriously fell below the standards expected of a doctor. It was also entitled to regard suspension, rather than reprimand or conditions, as necessary to recognise the seriousness of the convictions.
5. However, the Panel had materially overstated the claimant’s involvement by treating the fraud as having been perpetrated “primarily” by her daughter and by finding that she lacked insight into the enormity of her criminal conduct without adequate evidential support. The claimant had not participated directly in the fraud. She had assisted in retaining its proceeds while suspecting their criminal origin. Those errors affected the assessment of seriousness.
6. Having regard to the claimant’s serious but limited involvement, her professional record, the evidence of her competence, her personal circumstances, her remorse and the steps taken to repair harm, erasure was not necessary. Suspension for the maximum period available to the Panel, 12 months under section 35D(2)(b), was the appropriate substituted sanction.

The judgment records that the claimant had previously sought to appeal her criminal convictions, including the trial judge’s direction on the meaning of suspicion. The Court of Appeal upheld the direction, although it observed that the qualification of the ordinary meaning of suspicion might better have been omitted. The present proceedings concerned the separate professional sanction imposed by the Fitness to Practise Panel.