General Medical Council v Agrawal

When deciding whether to extend an interim order of conditions imposed on a medical practitioner, the court must balance the practitioner’s interests against the public interest. Relevant considerations include the gravity of the allegations, the nature of the evidence, the seriousness of the risk to patients, the reasons for delay, and the prejudice caused by continuation of the order. The court is the primary decision-maker and is not bound by, or required to defer to, the Interim Orders Panel. Its task is not to determine the truth of the allegations, but whether they justify prolonging the order. Unacceptable investigative delay and significant professional prejudice may justify limiting an extension to a short period.

The General Medical Council applied to extend an interim order of conditions imposed on Dr Agrawal’s registration. The order arose from allegations concerning clinical performance, patient management, and support for junior surgical staff. The investigation had continued for approximately 17 months and had previously been criticised for delay.

At an earlier hearing, Supperstone J had extended the order for three months only. The GMC sought a further ten-month extension. The central issue was whether continuation was justified and, if so, for what period, having regard to the competing public interest and the prejudice caused to the practitioner.

1. Balancing exercise. The court considered the factors identified in General Medical Council v Hiew [2007] 1 WLR 2007: the gravity of the allegations, the nature of the evidence, the seriousness of the risk of harm to patients, the reasons why the case had not been concluded, and the prejudice to the practitioner.
2. The court was the primary decision-maker. Although the Interim Orders Panel’s opinion was important, the court was neither bound by it nor required to defer to it. The court’s function was not to make primary findings about the truth of the allegations, but to decide whether the allegations justified prolonging the order.
3. The allegations were serious and supported by expert evidence, including a report from a consultant surgeon and a Royal College of Surgeons report. However, other eminent surgeons firmly contested the criticisms. That genuine professional disagreement was relevant to the assessment of risk.
4. The GMC was responsible for the delay. It had failed to progress important evidence and had not properly addressed the conflicting expert opinions. The delay was therefore a factor in favour of the practitioner. The conditions also caused significant prejudice by restricting his ability to obtain employment.
5. With hesitation, the court extended the order for three months only. The ten-month period sought was wholly inappropriate. Three months was considered more than sufficient for the GMC to complete the outstanding work and determine how the matter should proceed. The GMC’s application for costs was refused because the unrealistic application and the need for the contested hearing resulted from its conduct.

The judgment records that Supperstone J had previously extended the interim order for three months at a hearing on 29 October 2013. The present court granted a further three-month extension, rather than the ten months sought.