Remedy UK Ltd, R (on the application of) v The General Medical Council

The GMC’s fitness-to-practise jurisdiction is not confined to clinical treatment. Misconduct may arise in other functions forming part of a doctor’s medical calling, including sufficiently connected managerial, educational, research or expert work. The conduct or performance must nevertheless have a sufficiently close link with medical practice. Government health-policy work is not a medical function merely because it concerns doctors or affects the profession. The separate misconduct limb based on bringing the profession into disrepute requires dishonourable, disgraceful or morally censurable conduct. Reputational damage caused by good-faith but poor judgment is insufficient. Deficient professional performance may cover non-clinical incompetence, but only where the function forms part of the medical calling.

Remedy UK Ltd sought judicial review of the GMC Registrar’s decision not to refer complaints against two doctors involved in the development and implementation of MTAS and SSR to case examiners. The complaints alleged misconduct and deficient professional performance under section 35 C(2) of the Medical Act 1983. The Registrar considered that the allegations concerned government administration rather than clinical practice and were therefore outside the GMC’s fitness-to-practise jurisdiction.

The central issue was whether administrative functions in government health-policy work could constitute misconduct or deficient professional performance, and whether alleged damage to the profession’s reputation was sufficient to establish misconduct.

1. Application dismissed. The Registrar was entitled to stop the complaint at the initial stage because the allegations were incapable of falling within section 35 C(2) of the Medical Act 1983.
2. Under the GMC’s procedural rules, the Registrar asks whether the allegation is capable of producing a finding of misconduct or deficient professional performance. If it is outside section 35 C(2), it need not be referred to case examiners.
3. Misconduct has two principal forms. First, sufficiently serious misconduct in the exercise of a doctor’s medical calling may qualify even when it is not clinical. The necessary link depends on the circumstances. Roylance v General Medical Council (No 2) [2000] 1 AC 311 and Meadow v General Medical Council [2007] QB 462 show that relevant managerial, expert, educational or research functions may fall within the jurisdiction. Secondly, conduct outside professional practice may qualify where it is dishonourable, disgraceful or otherwise morally censurable and brings the profession into disrepute.
4. The doctors’ work concerned the making and implementation of government health policy. Their medical knowledge might assist them, but the essential functions were not medical and were too remote from medical practice. The same conclusion applied to both misconduct in the first sense and deficient professional performance. The latter may extend to serious incompetence in non-clinical functions forming part of a medical calling, but not to unrelated government administration.
5. Damage to the profession’s reputation, without morally censurable or disreputable conduct, does not itself constitute misconduct. Good-faith but inefficient or ill-judged committee decisions therefore did not satisfy the second limb.
6. The Registrar’s view that only clinical performance could be relevant was too narrow, but his ultimate conclusion was correct. Lack of particularity was not an independent basis for refusing referral; further particulars could have been sought.