Patel, R (On the Application Of) v General Medical Council

The GMC may define an acceptable overseas medical qualification by mandatory minimum criteria. Such criteria do not unlawfully fetter its statutory discretion, provided they remain within the bounds of Wednesbury reasonableness. Rationality must be assessed in the context of the GMC’s public-protection function, the absence of universally accepted standards and the criteria as a whole.

Common-law proportionality is not generally available unless a European or human-rights right is engaged. A representation that a qualification is accepted at the time it is made does not ordinarily promise that the criteria will remain unchanged. Any legitimate expectation must yield to express statutory requirements.

The claimant, a pharmacist who obtained an MBBS qualification from the International University of Health Sciences in St Kitts and Nevis, sought to sit the PLAB examination and obtain provisional registration with the GMC.

The GMC refused to accept his qualification because more than 50 per cent of the course had been undertaken outside the country awarding it. The claimant challenged the refusal, arguing that the 2010 criteria unlawfully fettered discretion, were irrational and disproportionate, and frustrated a legitimate expectation arising from GMC emails in 2004. He also argued that transitional provisions were required.

The central issues were whether the GMC could impose mandatory qualification criteria and whether the claimant could rely on the earlier representation despite subsequent changes to the criteria.

1. The claim was dismissed. The statutory scheme distinguished between holding an acceptable overseas qualification and possessing the knowledge and skill required for provisional registration. The two requirements could not be elided.

2. The phrase allowing registration “if the General Council think fit so to direct” created a discretion only after the Registrar was satisfied that the statutory criteria had been met. It did not permit registration where the applicant lacked an acceptable overseas qualification.

3. The GMC was entitled to identify minimum mandatory criteria for acceptable overseas qualifications. It acted as an expert body under a statutory scheme directed to protecting the public. The criteria were subject to Wednesbury review but did not unlawfully fetter a public-law discretion.

4. The 50 per cent rule was not irrational. It addressed wider concerns about the awarding institution’s control, supervision and support of the course, and formed part of a wider package of requirements, including restrictions on distance learning and the PLAB examination. The absence of transitional provisions did not make the criteria irrational.

5. Common-law proportionality was unavailable because no relevant European or human-rights right was engaged. Article 2 of Protocol 1 to the Convention protected access to education and related educational modalities, but not future professional registration. In any event, the criteria were not shown to be disproportionate.

6. The legitimate-expectation claim failed. The 2004 GMC emails were framed in the present tense and represented what was then accepted. They contained no clear and unequivocal promise that the criteria would remain unchanged. Further, an expectation founded on a representation contrary to statute could not prevail, and the public interest permitted the GMC to revise its criteria.

7. The claimant could not rely on the Registration Appeals Panel’s interpretation of the earlier criteria. He was unaware of that interpretation and had not relied upon it. No transitional protection was therefore required.

First-instance judicial review in the Administrative Court. The application was dismissed.