General Medical Council v George

On an application to extend an interim suspension, the court is the primary decision-maker. It must assess whether continuation serves the protection of patients, the public interest, or the practitioner’s own interests, giving appropriate weight to the regulator’s concerns and the prejudice caused by suspension.

Serious performance concerns do not lose their significance merely because they are old, particularly where investigation has been impeded by the practitioner’s lack of cooperation or ill-health. Performance and health may be assessed together where they are closely related. A further extension may be justified where assessment remains necessary to determine fitness to practise, but the regulator must proceed with the utmost expedition.

The General Medical Council applied for a further extension of an interim order suspending Dr George from practice under section 41A of the Medical Act 1983. The suspension had continued for about seven years while concerns about deficient performance, health and possible erosion of medical knowledge and clinical skills remained unresolved.

Earlier proceedings had exposed procedural difficulties, including invalid arrangements for a performance assessment under the 2004 Rules. The present application followed a further review by the Interim Orders Panel and concerned whether the court should extend the suspension for another 12 months while performance and health issues were investigated.

1. Application granted. The interim order of suspension was extended for a further 12 months. The court assessed the application as the primary decision-maker, applying the principles identified in General Medical Council v Hiew [2007] EWCA Civ 369 and adopted in the earlier judgment.
2. The relevant considerations included protection of the public, the public interest and the practitioner’s own interests; the gravity of the allegations; the evidence; the risk of harm to patients; the reasons for delay; and the prejudice caused by continued suspension. The GMC bore the burden of satisfying the court on the civil standard.
3. The court was concerned by the seven-year suspension and by delay for which the GMC bore some responsibility. However, those concerns were outweighed by the continuing need to investigate fitness to practise. The allegations did not become less significant merely through the passage of time where the GMC had sought to pursue them but assessment had been impeded.
4. Performance assessment did not cease to be relevant because of long-term ill-health. It could remain in abeyance while also informing the need to investigate health. The power under rule 7 of the General Medical Council (Fitness to Practise) Rules 2004 to direct assessment of performance or health was capable of encompassing both where the issues were closely related.
5. The evidence supported a real concern that Dr George’s medical knowledge and clinical skills might have deteriorated during his lengthy absence from practice. Assessment, rather than reliance on prospective employers, was the appropriate means of determining that issue. His reduced cooperation also diminished the weight to be given to prejudice and delay in the balancing exercise.
6. The court criticised the GMC’s very short notice of the application and summarily assessed its costs at £2,000. The GMC was expected to proceed with the utmost expedition.

First-instance application. The judgment records earlier extensions and an earlier judgment by Lloyd-Jones J, [2008] EWHC 1337 (Admin), but that decision was not an appeal from the present judgment.