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

On a statutory appeal against professional disciplinary sanction, the court’s function is supervisory. It must respect the specialist expertise of the Fitness to Practise Panel in assessing professional standards, misconduct, insight and the risk of repetition. A substantial hurdle applies where the challenge concerns findings based on oral evidence that the court did not hear. Repeated and serious misconduct, committed knowingly, may support an inference of a real risk of repetition, particularly where the practitioner has demonstrated insufficient insight. Erasure is justified where the totality of the misconduct is fundamentally incompatible with continued registration. Dishonesty, serious departures from professional standards, and persistent lack of insight are material indications, but the decisive question is the fundamental compatibility of the practitioner’s conduct with continued registration.

Dr Nashwa Sherif appealed against a Fitness to Practise Panel’s decision ordering her erasure from the medical register. The Panel had found numerous allegations proved or admitted, including working at unregistered clinics, inappropriate prescribing and supply of drugs, inadequate drug custody, inadequate patient histories, lending her name to treatment carried out by another doctor, and professional dishonesty in a reference concerning a suspended doctor.

The Panel concluded that the misconduct was fundamentally incompatible with continued registration. Dr Sherif challenged the findings concerning her insight and the risk of repetition, and argued that erasure was excessive, disproportionate and unnecessary. The central issues were the proper scope of the court’s review and whether the Panel was entitled to impose erasure.

1. Appeal dismissed. The court found no justification for interfering with the Panel’s decision. The Panel had been entitled to conclude that the established and admitted misconduct was fundamentally incompatible with continuing to be a registered medical practitioner.
2. The court’s role was one of review. It had to take account of the Panel’s professional qualifications and its particular competence to assess proper medical practice, the seriousness of misconduct, and whether a lesser sanction would suffice.
3. A challenge to findings about insight and risk of repetition faced a very significant hurdle. The court had not heard the oral evidence, especially Dr Sherif’s evidence, and was therefore not as well placed as the Panel to assess those matters.
4. The Panel was entitled to reject the significance of Dr Sherif’s apologies and subsequent proper work. Her evidence concerning her knowledge of the other doctor’s suspension had been inconsistent and evasive, and her reference did not demonstrate a straightforward acceptance of her dishonesty or the importance of truthfulness.
5. The number, duration and seriousness of the offences, together with the fact that they were committed knowingly, were capable of supporting an inference of a real risk of repetition. That inference was reinforced by the finding of a lack of significant insight.
6. The Panel had identified dishonesty, serious departures from professional standards and persistent lack of insight as indications that erasure might be appropriate. More importantly, it had assessed the totality of the misconduct as fundamentally incompatible with continued registration. A lesser sanction was therefore not appropriate.
7. The respondent was awarded costs summarily assessed at £8,000.28.

The Fitness to Practise Panel ordered Dr Sherif’s erasure from the medical register in its decision dated 6 February 2007. The High Court (Administrative Court) dismissed her statutory appeal and awarded the General Medical Council costs of £8,000.28.