Sharma, R (on the application of) v The General Dental Council

Impaired fitness to practise is assessed by reference not only to clinical risk to patients, but also to the protection of patients, the maintenance of proper professional standards and public confidence in the profession. A serious pattern of deficiencies in communication, informed consent and complaint handling may establish impairment even where clinical ability is high and the misconduct concerns one patient. The court should give considerable weight to a specialist professional committee’s evaluative judgment on impairment and sanction. Conditions may be imposed where a reprimand would not adequately address remediable deficiencies. A finding of impairment does not necessarily require a sanction, although sanctions will commonly follow.

The claimant, a registered dentist, appealed under section 30 of the Dentists Act 1954 against a Professional Conduct Committee decision. He accepted the findings that he had committed misconduct in treating one patient, but challenged the findings that his fitness to practise was impaired and that conditions should be imposed on his registration.

The misconduct involved failures concerning treatment planning, informed consent, sedation consent, aftercare and the handling of the patient’s complaints. The central issues were whether the committee had properly assessed impairment as at the hearing date and whether supervision, reporting and a personal development plan were proportionate.

1. Appeal substantially dismissed. The finding of impaired fitness to practise was upheld. The conditions were varied so that they applied until 27 January 2011 and were reviewed shortly before that date. The respondent’s costs were payable, subject to detailed assessment.
2. The court should give careful weight to the informed professional judgment of a specialist committee when reviewing its evaluation of impairment and sanction. That principle applied both to the assessment of fitness to practise and to the choice of sanction.
3. Impairment is broader than the risk of future clinical harm to an individual patient. It includes deficiencies whose continuation without correction or remedy would undermine patient protection, proper standards of professional conduct or public confidence in the profession. The relevant assessment is directed to the practitioner’s fitness at the hearing date and the future consequences of continued unremedied deficiencies.
4. The misconduct was not a single isolated act. It comprised widespread deficiencies over several months, including failures to provide adequate information and obtain informed consent, inadequate aftercare and dismissive treatment of a justified complaint. The claimant’s clinical reputation and previous unblemished record did not overcome the absence of objective evidence demonstrating insight and remediation in communication, consent and complaint handling.
5. Although the statutory language indicated that a sanction was discretionary, a reprimand would not adequately address the deficiencies identified. Conditions were remedial rather than punitive. Supervision remained necessary, and the error giving the Postgraduate Dean a role did not undermine the substance of the committee’s decision.

The judgment does not state a prior appellate history. The claimant appealed the Professional Conduct Committee’s decision to the Administrative Court under section 30 of the Dentists Act 1954.