Bhatia v General Medical Council

Where the applicable registration guidance requires investigation of a non-consecutive internship, it does not prescribe the outcome of that investigation. The decision-maker must make a fact-specific assessment of whether the applicant has demonstrated the experience required by section 21B(1)(b) of the Medical Act 1983.

Earlier, less prescriptive guidance must not be interpreted by importing stricter requirements introduced by later guidance. Relevant matters include the length and nature of any interruption, the substantial proportion of training completed before it, and the overall training programme. A specialist tribunal must confront the central facts and explain its conclusion.

The appellant, a doctor trained in India, applied to the General Medical Council for full registration under section 21B of the Medical Act 1983. She had completed more than 12 months of supervised internship, including the required periods in medicine and surgery, but the internship had been interrupted by family circumstances, clinical electives and study.

The Assistant Registrar and the Registration Appeal Panel refused the application. The Panel considered both the guidance in force when the application was made and later, more prescriptive guidance, and concluded that their overall effect was the same. The appeal concerned which guidance applied and whether the earlier guidance required the interruption to result in refusal.

1. The appeal was allowed under CPR 52.11(3). The Panel’s decision was wrong in law and was quashed.
2. The guidance in force when the application was made was the applicable guidance. The later guidance could not be used to determine the application through transitional arrangements.
3. The earlier guidance required a 12-month programme, with specified experience in medicine and surgery. It stated that a non-consecutive programme might require investigation. It did not say that an interrupted programme ceased to be a programme, nor did it prescribe that the application must fail.
4. The decision-maker therefore had to investigate and evaluate the applicant’s experience on the facts. The length of an interruption could be relevant, but the assessment remained open-textured and had to address whether the applicant had satisfied section 21B(1)(b) of the Medical Act 1983.
5. The Panel erred by treating the earlier and later guidance as having the same overall effect. The later guidance was materially more prescriptive, requiring continuous and uninterrupted practice subject to specified limits. Importing that approach into the earlier guidance was legally wrong.
6. The Panel also failed to confront the significance of the appellant having completed almost the whole of the internship before the interruption, and to explain why that circumstance did or did not demonstrate the necessary experience.
7. The case was remitted to the Registrar for referral to a Registration Appeals Panel. The new Panel was required to apply the earlier guidance and assess the length of the gap, the substantial period completed beforehand and the overall duration of the programme without being influenced by the later prescriptive approach.

• High Court (Administrative Court): The appeal from the Registration Appeal Panel was allowed. The Panel’s refusal decision was quashed and the matter was remitted for reconsideration.