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

On an appeal under section 40 of the Medical Act 1983, the High Court must correct material errors of fact or law and review the application of legal principles, but must accord special respect to the specialist tribunal’s judgment. A finding of “cause for concern” does not mean that the relevant performance criticism must be disregarded. It records evidence which may be insufficient to classify performance as unacceptable, but which remains relevant to overall competence and patient safety. Conditions on registration must be appropriate, proportionate, workable and measurable, and sufficient to protect patients. A doctor may be remediable while conditional registration is nevertheless inadequate. Suspension may therefore be proportionate where workable conditions cannot adequately manage the risk to patients.

The claimant appealed under section 40 of the Medical Act 1983 against a decision of a General Medical Council Fitness to Practise Panel. The panel had found his fitness to practise impaired by deficient professional performance and suspended his registration for 12 months. The claimant challenged the panel’s assessment of findings recorded as “cause for concern”, its reasoning on the feasibility of conditions, and the proportionality of suspension. The central issues were whether the panel had misunderstood the assessment report, whether its reasons were adequate, and whether suspension was a lawful and proportionate response.

1. The appeal was dismissed. The court applied the approach summarised in Raschid v General Medical Council [2007] 1 WLR 1460. The High Court must correct material errors of fact and law and make a secondary judgment on the application of legal principles, while giving special respect to the specialist panel, particularly where professional standards and patient protection are concerned.

2. The panel was entitled to consider the nine categories assessed as “cause for concern”. That classification meant that there was insufficient evidence to classify the performance as unacceptable. It did not mean that the matters were irrelevant or that the claimant had established competence in those areas. The concerns involved serious criticisms and could properly contribute to the assessment of the breadth of deficiencies and lack of fundamental core skills.

3. The panel was also entitled to take account of the claimant’s examination results, including his position among the lowest-performing doctors assessed. Doing so did not involve an error of law or impermissible second-guessing of the assessment team.

4. The panel’s conclusion that conditional registration was insufficient was adequately reasoned. The precise recommendations for close supervision and prohibition on independent work could not be replicated. The alternative arrangements discussed in evidence did not, in the panel’s view, provide conditions sufficient to protect patients. The panel was entitled to rely on the breadth of the deficiencies, the lack of core skills, the claimant’s continuing absence from practice and the real risk to patient safety.

5. Remediability and the adequacy of conditions were separate questions. The panel could accept that the claimant had potential for rehabilitation while concluding that conditional registration was not sufficiently protective. Suspension for 12 months, with review and recommended evidence of remediation, was therefore appropriate and proportionate. Costs were ordered on an interim basis in the sum of £15,000, including VAT, with the balance to detailed assessment if not agreed.

• General Medical Council Fitness to Practise Panel: found the claimant’s fitness to practise impaired by deficient professional performance and directed suspension of his registration for 12 months.
• High Court (Administrative Court): dismissed the section 40 appeal and ordered an interim payment of costs of £15,000, with the balance to detailed assessment if not agreed.