General Medical Council v Dr E

On an application to extend an interim order under section 41A of the Medical Act 1983, the court may refuse the requested extension, grant a shorter extension, or vary the conditions. It applies the same protective and public-interest criteria as the Interim Orders Panel. The court considers the allegations rather than determining their truth, but may discount evidence that is manifestly unreliable. Delay is material because conditions proportionate when imposed may become disproportionate over time. Conditions must represent the minimum interference necessary to protect patients and the practitioner. Where the risk concerns grooming or an inappropriate relationship with a vulnerable patient, tailored restrictions may be proportionate even though a general chaperone requirement would have the practical effect of suspension.

The General Medical Council applied under section 41A of the Medical Act 1983 to extend for 12 months interim conditions imposed on Dr E. The conditions substantially prevented him from working as a general practitioner because female-patient consultations generally required a qualified chaperone.

Dr E resisted the extension on grounds of disproportionality, the practical effect of the conditions, and delay in investigating allegations that he had raped and formed an inappropriate relationship with a vulnerable former patient. The GMC also relied on an allegation concerning Dr E’s probity. The central issues were the reliability that could be given to the evidence, the effect of delay, and the appropriate protective conditions and duration.

1. Statutory power and test. The court applied GMC v Hiew [2007] EWCA Civ 369; [2007] 1 WLR 2007. Under section 41A(7) of the Medical Act 1983, the court could refuse the requested extension, grant a shorter extension, vary the conditions, or otherwise determine the appropriate period. The criteria were the same as those applicable to the original Interim Orders Panel.
2. The court was not to determine primary facts or the merits of the allegations. It had to assess whether the allegations justified prolonging the order. It was nevertheless entitled to discount evidence that was manifestly unreliable, applying the qualification identified in Perry v NMC [2013] EWCA Civ 145.
3. The uncorroborated rape allegations were so inherently unreliable that it was unsafe to proceed on them, save where agreed or independently supported. The remaining material credibly indicated a relationship with a vulnerable former patient and an isolated probity concern. Those matters justified interim protection, but did not justify practical suspension.
4. Delay was a material proportionality consideration. Conditions that were proportionate when imposed could become disproportionate with the passage of time. The GMC’s investigation had suffered substantial unexplained delay, although the vulnerability of the principal witness required appropriate care.
5. The existing chaperone condition was replaced by tailored restrictions on personal, telephone and electronic contact, the frequency of consultations, and contact outside appointments. Dr E was required to offer a chaperone at every consultation with a female patient. The varied conditions enabled limited practice while addressing the identified risks.
6. The conditions were extended for six months, rather than the 12 months sought. The claim was allowed to that extent.