General Medical Council v Adekola

On an application to extend an interim order under Medical Act 1983, the court is the primary decision-maker. It must assess the need for continuation afresh rather than merely review the Interim Orders Panel’s earlier decision.

Relevant considerations include the gravity of the allegations, the evidence, the risk of harm to patients, the reasons for delay, and prejudice to the practitioner. The burden rests on the General Medical Council to establish that an extension is necessary and appropriate. The court must balance public protection and the integrity of the profession against the practitioner’s interests.

The General Medical Council applied under section 41A(6) of the Medical Act 1983 to extend for nine months an interim order of conditions imposed on Dr Rapinder Adekola. The order followed serious allegations concerning her conduct, professional relationships, prescribing, and attempted procurement of toxic venoms. The order was due to expire on 28 February 2013.

Dr Adekola opposed the extension, relying on delay, the absence of identified clinical concerns, the effect of continued restrictions on her ability to work, and proposed variations to the conditions. The central issues were whether an extension was justified and whether the court should vary the conditions.

1. The GMC’s application was granted. The interim order was extended for nine months, comprising three months plus six months, until 27 November 2013.
2. Under section 41A(6) and (7) of the Medical Act 1983, the court is the primary decision-maker. It is not confined to reviewing the earlier determination of the Interim Orders Panel. The court must consider all relevant circumstances, including the gravity of the allegations, the nature of the evidence, the risk of harm to patients, the reasons why the substantive case remains unresolved, and prejudice to the practitioner: [2007] EWCA Civ 369, paras 26 and 28.
3. The burden of persuading the court that an extension is necessary and appropriate rests on the GMC. In this case, the allegations, individually and collectively, provided a formidable basis for considering that Dr Adekola’s fitness to practise might be impaired. The public-protection duty was therefore strongly engaged.
4. The GMC had progressed the case with reasonable expedition in the circumstances. Delay was partly attributable to Dr Adekola’s late response to a requested health assessment. Although continuation of the order had materially affected her ability to work, the conditions did not wholly prevent practice. The need to protect patients and maintain confidence in the profession outweighed that prejudice for the further period sought.
5. The court declined to consider proposed variations to the conditions. No formal application for variation had been made, and it was unclear whether section 41A(10) empowered the court to make such an order. It would ordinarily be rare for the court to vary conditions without the benefit of the Interim Orders Panel’s prior consideration. Any variation application could be made to that Panel.
6. The GMC was awarded £1,090.80 in costs, subject to the usual order relating to Dr Adekola’s public funding.