Siddiqui v General Medical Council

An appeal under section 40 of the Medical Act is a rehearing, but the appellant must show that the Fitness to Practise Panel’s decision was wrong. The court corrects material errors of fact or law and exercises a secondary judgment, giving particular respect to the specialist tribunal’s assessment of professional matters, especially sanction.

Dishonesty by a medical practitioner harms public confidence in the profession even where no patient suffers financial loss. A good professional record, personal hardship, stress, insight and a low risk of repetition are relevant, but they do not make suspension disproportionate where the sanction is necessary to maintain public confidence.

The claimant, a general practitioner, appealed under section 40 of the Medical Act against a Fitness to Practise Panel’s decision to suspend her registration for six months.

The Panel found that she had provided inadequate clinical care, dishonestly altered a patient’s medical records after learning of the patient’s deterioration, and subsequently made dishonest and misleading statements during the investigation. The claimant accepted the factual findings and challenged only the sanction, relying on stress, an otherwise unblemished career, favourable testimonials, personal hardship and the practical effect of suspension on her ability to practise.

The central issue was whether the Panel’s decision was wrong and whether the six-month suspension was disproportionate.

1. The appeal was a rehearing rather than a public law review. The claimant nevertheless had to demonstrate that the Panel’s decision was wrong. The court could correct material errors of fact or law and exercise a secondary judgment, but had to give particular weight to the specialist tribunal’s professional assessment, especially on sanction: [2007] EWCA Civ 46; [2009] EWHC 645 (Admin).

2. Dishonesty by a professional engages the public interest in maintaining confidence in the profession. The absence of financial loss or other direct harm to a patient does not exhaust the concept of harm to the public. That principle applied equally to registered medical practitioners: [2010] EWHC 2022 (Admin); [2012] EWHC 2976.

3. The Panel had properly considered the claimant’s long and previously unblemished career, stress, favourable testimonials, insight, approaching retirement and low risk of repetition. Those matters did not outweigh the need to mark the seriousness of dishonesty and maintain public confidence. The claimant’s personal and professional hardship could not make suspension wrong where suspension was otherwise justified: [1994] 1 WLR 512.

4. There was no tenable basis for concluding that the six-month suspension was wrong. The appeal was dismissed. The GMC was awarded its costs. On summary assessment, the aggregate costs were disproportionate; applying Lownds v The Home Office, the court assessed the necessary and reasonable items individually and reduced the amount claimed.

The judgment does not state any earlier appellate decision. The claimant appealed directly to the Administrative Court under section 40 of the Medical Act against the Fitness to Practise Panel’s sanction.