Watson v General Medical Council

Professional performance is seriously deficient where conduct repeatedly or persistently falls below the appropriate professional standard and is sufficiently serious to call a doctor’s registration into question. A lack of qualifications may support that conclusion but cannot, without more, establish serious deficiency.

An appeal from a Fitness to Practise Panel is principally a review. Fresh evidence is not automatically admissible. It should be received only where the interests of justice require it, which will be rare, particularly where competent advisers failed to place the evidence before the Panel.

Although there is no general statutory duty to give reasons, good practice ordinarily requires concise reasons. Failure to give reasons is not necessarily fatal where the decision and its evidential basis are apparent.

The applicant, a registered psychiatrist, appealed under Medical Act 1983 section 40(1)(a) against a Fitness to Practise Panel decision under the General Medical Council (Professional Performance) Rules 1997. The Panel found his professional performance seriously deficient in several respects and imposed conditions on his registration for two years.

The appeal challenged the admission of expert evidence, the Panel’s factual findings concerning two patients, its treatment of complaints, record keeping and audit, the adequacy of its reasons, and several procedural decisions. The central issues were the proper scope of an appeal from a Fitness to Practise Panel, the threshold for receiving fresh evidence, and whether the Panel’s findings were legally sustainable.

1. Appeal dismissed. The Panel was entitled to find that the applicant’s performance was seriously deficient. The applicable test, reflected in the GMC Guidance and approved in Sadler v GMC (Appeal No 59 of 2002), required repeated or persistent conduct falling below the professional standard appropriate to the work and sufficiently serious to call registration into question. The applicant’s qualifications were relevant but would not alone have established serious deficiency.
2. An appeal under Medical Act 1983 section 40 was in substance a review, notwithstanding that the relevant Practice Direction described it as a rehearing. Under Civil Procedure Rules 1998 rule 52.11(2), fresh oral or documentary evidence was excluded unless the court ordered otherwise. The approach in Nandi v GMC ([2004] EWHC 2317 (Admin)) was qualified only to recognise that evidence might exceptionally be admitted where the interests of justice required it. That exception would rarely apply. Adviser error, without more, was not a sufficient reason.
3. The proposed independent psychiatric report was properly excluded. It dealt largely with one patient, did not address the whole evidential picture, and would not have assisted the applicant even if admitted.
4. The Panel was entitled to reject the applicant’s accounts where they conflicted with other evidence or his contemporaneous notes. In relation to patients AB and DE, it could find that he had acted irresponsibly, failed to consult colleagues, and applied the relevant provisions of the Mental Health Act 1983 inappropriately. The Panel was also entitled to rely on the nature of patient complaints, deficient record keeping, and the absence of meaningful audit or reflective practice.
5. Following Gupta v GMC ([2002] 1 W.L.R. 1691), there was no general legal duty requiring reasons in every case. Good practice nevertheless normally required reasons. The Panel’s concise decision sufficiently disclosed its conclusions and the evidential basis for them.
6. The remaining procedural complaints could not affect the result. The appeal was dismissed. Costs were awarded in principle, subject to the applicant’s opportunity to make written submissions on liability and amount.

The judgment describes an appeal to the Administrative Court from a Fitness to Practise Panel decision dated 15 April 2005. No earlier court judgment is identified.