Macavei v General Dental Council

On an appeal from a professional disciplinary sanction, the court asks whether the tribunal’s decision was wrong or unjust because of serious procedural or other irregularity. Considerable weight is given to a specialist tribunal’s assessment of impairment and sanction, particularly where it has heard the registrant’s evidence. Intervention is justified only where the decision is clearly inappropriate.

Insight, remediation, technical competence and willingness to comply with professional requirements may be relevant to impairment and sanction. Erasure may be proportionate where serious deficiencies remain, remediation has not been demonstrated, workable conditions cannot protect the public, and suspension is unlikely to produce improvement.

The Professional Conduct Committee of the General Dental Council found that the appellant’s fitness to practise was impaired by misconduct arising from serious deficiencies in clinical practice, treatment planning, radiography and record keeping. It ordered her erasure from the register.

The appellant accepted the factual findings but argued that the Committee should not have relied on an earlier NHS performance process because she did not intend to undertake NHS work. She also challenged the conclusion that conditions or suspension would not adequately protect the public. The central issue was whether the Committee’s decision was wrong, or unjust because of serious procedural or other irregularity, under section 29 of the Dentists Act 1984 and CPR 52.11.

1. Appeal dismissed. The appeal court’s task under section 29 of the Dentists Act 1984 and CPR 52.11 was to determine whether the PCC’s decision was wrong or unjust because of a serious procedural or other irregularity. The court did not conduct a rehearing or substitute its own assessment of sanction.
2. The PCC was entitled to consider the appellant’s earlier NHS performance process. The advice that she refrain from practice was unqualified and applied to private as well as NHS practice. Her response to that advice, and her failure over a prolonged period to engage adequately with the personal development plan process, were relevant to insight, remediation and commitment to professional standards.
3. The PCC had ample evidence that the appellant had little insight into her deficiencies. Its conclusion that she could not practise safely without restriction, or at all, was open to it. The failure to participate fully and responsibly in remediation was relevant to the protection of the public.
4. The PCC correctly considered sanctions in ascending order of seriousness and applied proportionality. Conditions had to be clear, workable and achievable. Given the deficiencies in basic clinical knowledge and skills, the extensive supervision required, and the absence of sufficient insight and demonstrated learning, the PCC was entitled to conclude that workable conditions could not adequately protect the public.
5. Suspension was reasonably rejected because the appellant had undertaken little effective remediation over several years and the PCC had no confidence that suspension would produce improvement. The guidance indicated that failure to maintain professional knowledge and competence was a circumstance in which refusing erasure required careful justification. The PCC had heard the appellant at length and was best placed to assess her attitude and evidence. Its decision could not be said to be wrong, and due deference was required.

The appeal was dismissed. The court invited submissions on the final order and costs.

The judgment records an appeal from the Professional Conduct Committee of the General Dental Council. The Committee’s decision of 8 July 2014 found impairment and ordered erasure. The High Court dismissed the appeal.