Otote v General Medical Council

A professional regulator may find fitness to practise impaired where a practitioner fails to demonstrate that medical knowledge and skills remain adequate for safe practice, particularly in the context of limited insight into identified shortcomings. A practitioner’s compliance with registration conditions does not itself establish fitness to practise. At a review hearing, the statutory procedure does not require separate stages of evidence, and the word “or” may encompass one or both of the matters under review. Conditions and suspension are alternative sanctions, but conditions may remain operative until a deferred suspension takes effect.

Dr Otote appealed against a decision of a Fitness to Practise Panel of the General Medical Council following review of conditions previously imposed on his registration. The Panel found that he had complied with the conditions but had not shown that his medical knowledge and skills were adequate for safe clinical practice. It also considered that he lacked insight into the need to demonstrate competence, and imposed a 12-month suspension.

The appeal challenged the findings of impairment, the procedure adopted under regulation 22 of the General Medical Council (Fitness to Practise) Rules Order of Council 2004, and the relationship between conditions and suspension under section 36 of the Medical Act.

1. Appeal dismissed. The Panel was entitled to find that fitness to practise was impaired. Compliance with the existing conditions was not determinative. The central issue was whether Dr Otote had demonstrated that his medical knowledge and skills were adequate for safe clinical practice. His failure to obtain appropriate supervised employment, together with his refusal to undergo a Phase II Performance Assessment and his limited insight into the need to establish competence, provided a proper basis for the finding.
2. The Panel was required to consider impairment and sanction as separate stages. It was entitled to conclude that no conditions could be formulated which were appropriate, proportionate, workable and measurable, and therefore to impose a 12-month suspension for public protection and in the public interest.
3. Section 36(1) of the Medical Act provides alternative sanctions. The Panel had not imposed conditions and suspension concurrently. The conditions remained in place only until the suspension took effect; once suspension became operative, it superseded the conditions. The Panel was also entitled to indicate that a satisfactory Phase II Performance Assessment would assist a future review.
4. Regulation 22(d) and (e) of the General Medical Council (Fitness to Practise) Rules Order of Council 2004 did not require two separate stages for receiving evidence. Regulation 22(e) required the Panel to receive further evidence relevant to impairment or non-compliance, and “or” covered either or both matters.
5. The two appeals were dismissed. The GMC was awarded costs, summarily assessed at £6,000. The court indicated that, given Dr Otote’s financial position and inability to work as a doctor while suspended, the GMC should carefully consider whether enforcement would serve any purpose.

• General Medical Council Fitness to Practise Panel: on review, found fitness to practise impaired and imposed a 12-month suspension after concluding that workable and proportionate conditions could not be formulated.
• High Court (Administrative Court): dismissed both appeals and awarded the GMC £6,000 in costs.