Parchure v The General Medical Council

On an appeal from a professional disciplinary tribunal, the court must respect the tribunal’s specialist expertise and its assessment of witnesses. Findings of primary fact, especially those based on credibility, are difficult to overturn. The appellate court asks whether the tribunal’s decision was wrong, applying the generous ambit of reasonable disagreement. That restraint is especially relevant to impairment and sanction, but does not require deference on factual issues lacking a professional or medical dimension. A tribunal may reject a narrowly framed allegation about the contents of a job plan while finding that the practitioner remained contractually obliged to work for the NHS during relevant hours. Dishonest denials to professional superiors and dishonest evidence before the tribunal may properly found misconduct, impairment and suspension.

The appellant, a consultant cardiologist employed by an NHS trust and also undertaking private practice, appealed under section 40 of the Medical Act 1983 against findings by a Fitness to Practise Panel that he had committed misconduct, that his fitness to practise was impaired, and that he should be suspended for six months.

The allegations concerned representations made at meetings in 2008 about his private work and whether he had undertaken that work during NHS hours. The panel rejected some allegations, including allegations concerning the existence of a job plan committing him to particular clinics, but upheld allegations that he had made misleading statements, undertaken private work without authorisation during NHS hours, and acted dishonestly. The central issues were whether the panel’s factual findings and finding of dishonesty were wrong, and whether impairment and sanction could stand.

1. The appeal was dismissed. The panel’s findings of misconduct, impairment and the six-month suspension were upheld.
2. On an appeal from a professional tribunal, the court must give appropriate weight to the tribunal’s specialist understanding of professional standards and to its opportunity to hear and see the witnesses. The appellate test is whether the decision was wrong. A finding should not be overturned merely because the appellate judge would have reached a different conclusion; the tribunal’s conclusion must exceed the generous ambit within which reasonable disagreement is possible.
3. The specialist-tribunal principle applied principally to impairment and sanction, rather than to factual findings which did not depend on medical expertise. Nevertheless, findings of primary fact based on credibility were particularly difficult to overturn. The panel had carefully assessed the evidence, exercised caution concerning the witnesses’ recollection, and relied on contemporaneous documents. Its assessment of credibility was open to it.
4. The panel’s findings were not inconsistent. The allegation that the appellant had a job plan requiring attendance at particular clinics was narrowly framed and was not proved because no such plan existed. That did not exclude the relevance of existing contractual obligations or the absence of evidence that private work during NHS hours had been authorised. The finding that he was obliged to undertake NHS work during the times alleged, and had undertaken private work then, was therefore sustainable.
5. The panel was entitled to find that the appellant had denied statements he had made and had sought to conceal unauthorised private work. His dishonesty was aggravated by dishonest evidence given at the hearing. Although he had worked more than the hours for which he was paid and had not defrauded the NHS, those matters did not make the dishonesty findings wrong. Once dishonesty was upheld, the findings of impairment and sanction were also sustainable.

The judgment does not state the earlier decision’s citation. The appeal was brought from findings and sanction imposed by a Fitness to Practise Panel of the Medical Practitioners Tribunal Service.