Hussain v General Medical Council

On an application under section 41A(10) of the Medical Act 1983, the court exercises an original jurisdiction and decides for itself whether an interim conditional registration order should be revoked or varied. It may consider subsequent developments and fresh evidence. The court must give appropriate, but not automatic, weight to the Interim Orders Panel’s decision. That weight depends particularly on the quality of the panel’s reasoning and its engagement with the parties’ arguments. Interim conditions must be necessary for public protection, or at least desirable in the public or practitioner’s interest, and proportionate to the identified risk. Conditions imposed to address patient-safety concerns cannot readily be justified where those concerns are no longer relied upon and the remaining allegations concern low-level, historic probity matters that do not bear on current patient safety.

The claimant, a registered medical practitioner, applied under section 41A(10) of the Medical Act 1983 to revoke or vary an interim conditional registration order imposed and repeatedly continued by Interim Orders Panels of the General Medical Council. The order restricted him to supervised NHS middle-grade accident and emergency work and imposed notification, reporting and minimum-placement conditions.

The GMC relied initially on patient-safety and probity concerns. By the time of the hearing, its Rule 7 letter relied on historic and further probity allegations but no longer alleged impairment by reference to patient-safety matters. The central issues were the court’s jurisdiction, the weight to be given to the existing order, and whether continuing the conditions remained necessary, desirable and proportionate.

1. The application was granted. The court directed revocation of the interim conditional registration order.
2. Section 41A(10) confers an original jurisdiction. The court is not confined to a judicial-review inquiry and may consider subsequent developments and fresh evidence. Although it must start from the fact that an extant order was made by an Interim Orders Panel, it must decide for itself whether that order should remain.
3. The court must attach such weight to the panel’s decision as the circumstances warrant. The panel’s statutory responsibilities and expertise do not create automatic deference. Weight depends on the persuasiveness and content of the reasons, including whether the panel addressed the substance of the arguments and explained why competing material was accepted or rejected. Formulaic reasoning and recital of submissions substantially limit the weight available.
4. The relevant inquiry is whether interim relief is necessary for protection of the public, or at least desirable in the public interest or in the interests of the practitioner. In every event, the conditions must be proportionate. The assessment is fact-sensitive and requires the likely harm from their removal to be balanced against the restriction imposed on the practitioner.
5. The original order appeared to have been directed principally at patient-safety concerns. Those concerns no longer featured in the GMC’s case. The remaining matters were low-level, historic probity allegations, many arising during a period of stress, with no demonstrated current connection to patient safety. The earlier breach of conditions had resulted in a short suspension, which was later lifted, and was not relied upon in the GMC’s current allegations.
6. The continuing restrictions were not shown to be necessary, desirable or proportionate. They significantly fettered the claimant’s practice in accident and emergency medicine, where the evidence showed competence and no patient-safety allegations. The court therefore revoked the order. The claimant recovered his costs, summarily assessed at £3,895.