Irvine v The General Medical Council

On a second appeal from professional disciplinary proceedings, permission requires a real prospect of success and either an important point of principle or practice or another compelling reason. Appellate courts should respect factual findings made by the specialist tribunal that heard the evidence, especially credibility findings, and should interfere with sanction only where it is clearly inappropriate. A doctor’s duty to obtain adequate insurance or professional indemnity cover is not satisfied merely by holding assets capable of meeting claims. Annual indemnity arrangements comprise separate yearly contracts. Permission was refused because none of the proposed grounds had a real prospect of success or met the second-appeal threshold.

The appellant sought permission for a second appeal against Holroyde J’s dismissal of his appeal from findings by a Medical Practitioners Tribunal. The Tribunal found that he lacked professional indemnity cover for private practice between 1 October 2007 and 23 February 2012, had acted dishonestly, was impaired, and should be erased from the register. The proposed appeal challenged the factual findings, the meaning of adequate cover, the dishonesty finding, and the proportionality of erasure. The appellant also sought a stay and relief based on an alleged breach of an injunction. The central question was whether any ground met the second-appeal permission test.

1. Under the Civil Procedure Rules rule 52.7, permission for a second appeal required a real prospect of success and an important point of principle or practice, or another compelling reason. Although the issues were important, none of the grounds satisfied either limb of the test.
2. The High Court’s rehearing of the Tribunal’s decision did not involve hearing the evidence afresh. Under Civil Procedure Rules rule 52.21(3), and absent serious procedural irregularity, the question was whether the Tribunal was wrong. Findings based on witness credibility were particularly difficult to disturb, consistently with Southall v General Medical Council [2010] EWCA Civ 407.
3. The indemnity arrangements were annual contracts, with each renewal constituting a new one-year contract. The evidence entitled the Tribunal and Holroyde J to conclude that MPS cover ended in 2007 and MDU cover began only in 2012. A standing direct-debit authority did not establish continuing cover. Nor could the appellant rely on sufficient personal assets: paragraph 34 of Good Medical Practice required insurance or professional indemnity cover.
4. The Tribunal was entitled to infer dishonesty from the appellant’s conduct, correspondence and pattern of inaccurate and untruthful statements. There was no arguable legal error in the Tribunal’s reasoning or in Holroyde J’s conclusion that the inference was overwhelming.
5. Professional disciplinary tribunals are entitled to particular respect on sanction because professional judgment has been entrusted to them. The court should intervene only where the sanction is clearly inappropriate. Erasure was unimpeachable in light of the findings of dishonesty and risk of further misconduct. Bijl v General Medical Council [2001] UKPC 42 was factually distinguishable, while the principle in Cheatle v General Medical Council [2009] EWHC 645 (Admin) supported restraint.
6. Permission to appeal was refused on all grounds. The stay and contempt applications were therefore unnecessary and were also refused.

1. Court of Appeal (Civil Division) Refused permission to appeal on all grounds and refused the associated stay and contempt applications.
2. High Court (Administrative Court) Holroyde J dismissed the appellant’s appeal against the Tribunal’s findings and sanction in [2017] EWHC 2038 (Admin).
3. Medical Practitioners Tribunal Made findings of impairment by dishonesty on 6 December 2016 and imposed erasure from the register on 21 December 2016.