Inayatullah v General Medical Council

An appeal under the Medical Act 1983 is a rehearing rather than a review, but the court gives appropriate respect to factual findings based on witnesses seen and heard and to professional judgment. Fitness to practise requires a two-stage assessment: whether misconduct or another statutory ground is established, followed by whether fitness is impaired. The civil standard of proof remains constant, although serious allegations require careful scrutiny of the evidence. A criminal-style good-character direction is not invariably required in professional disciplinary proceedings. A legal assessor’s advice invalidates the decision only if it was sufficiently unfair or significant to cast doubt on the result. Where dishonesty and serious clinical failings are established, erasure may be proportionate.

The appellant, a general practitioner, appealed under sections 38 and 40 of the Medical Act 1983 against a Fitness to Practise Panel’s findings that he had committed clinical misconduct and dishonesty, was impaired in fitness to practise, and should be erased from the medical register.

The appeal challenged the legal assessor’s directions on probabilities and good character, the Panel’s treatment of competing expert evidence, the clinical findings, and the sanction. One pleaded ground was abandoned. The central issues were whether the Panel’s decision was wrong or unfair and whether the sanction should be disturbed.

1. Appeal dismissed. The appeal jurisdiction under section 40 was by way of rehearing, not judicial review or a de novo retrial. The court had to consider the material for itself, while showing appropriate deference to factual findings based on witnesses seen and heard and to professional judgment, particularly on impairment and sanction ([2014] EWHC 3751 (Admin), paras 28–35).
2. The direction on probabilities was adequate. There is one civil standard of proof, the balance of probabilities. Serious allegations require appropriately careful examination of the strength and quality of the evidence, but do not require a heightened standard. The assessor had expressly addressed the seriousness of dishonesty and the need for heightened scrutiny (paras 33–35, 41–45).
3. A good-character direction analogous to that used in criminal proceedings was not legally required. Professional disciplinary proceedings are not closely analogous to a criminal trial, and the Panel could be expected to understand the relevance of the appellant’s professional status and character to credibility and propensity without a formal direction (paras 36–37, 46–48).
4. The dishonesty finding was supported by the patient’s evidence, the unaltered video recording, the inaccurate record, and the appellant’s evasive and changing evidence. There was no legal basis to interfere with it (paras 49–50).
5. The Panel was entitled to reject the defence expert’s opinion where it considered that the evidence lacked sufficient independence and relied on intuition rather than an adequate medical history. It could also form its own conclusions on matters illuminated by the recordings and factual evidence (paras 51–54).
6. Once dishonesty and serious clinical failings stood, the conclusion that erasure was appropriate was unimpeachable. The sanction was not re-sentenced by the court and was not disturbed. The appellant was ordered to pay the respondent’s costs, with detailed assessment if not agreed. Permission to appeal was refused (paras 55–56, 70, 82, 90).

The judgment describes an appeal under sections 38 and 40 of the Medical Act 1983 from findings and sanction imposed by a General Medical Council Fitness to Practise Panel. The Panel found misconduct, impairment, and directed erasure. The Administrative Court dismissed the appeal, ordered costs to the GMC, and refused permission to appeal.