General Medical Council v Lamming

On an application for restoration to the medical register, the applicant must satisfy the Tribunal that the evidence establishes fitness to practise. The Tribunal must address the central issues arising from the evidence, including any material change in the applicant’s account, its effect on propensity for dishonesty, and the applicant’s insight. It is not enough to acknowledge inconsistencies and then assess only selected evidence of remorse or insight. A Tribunal may not re-litigate facts already found proved, but it must evaluate later evidence and changes in that evidence where they bear on current fitness. Reasons must be intelligible, address the substance of the parties’ central arguments, and disclose that the necessary reasoning process was undertaken.

The General Medical Council appealed under section 40A of the Medical Act 1983 against the Medical Practitioners Tribunal’s decision of 10 February 2017 to restore Dr Christopher Lamming to the medical register under section 41. Dr Lamming had previously been suspended for dishonest representations about his qualifications and erased after dishonest retention of salary payments. The GMC argued that his evidence in 2017 materially differed from his earlier evidence and that the Tribunal had failed to address continuing dishonesty, propensity and lack of insight. The central issue was whether the Tribunal’s reasons adequately dealt with those matters before concluding that the dishonesty had been remediated.

1. The appeal was allowed and the Tribunal’s decision was quashed. The application for restoration was remitted to a differently constituted Tribunal for re-determination under section 40A(6) of the Medical Act 1983.

2. Under section 41(6) of the Medical Act 1983, the applicant for restoration bears the burden of providing evidence satisfying the Tribunal of fitness to practise. The Tribunal had to consider whether the evidence resolved in Dr Lamming’s favour the issues identified in the earlier decision: insufficient insight, propensity for dishonesty, changed evidence, and the risk of recurrence.

3. The Tribunal was entitled not to re-litigate the facts found proved in 2007. That did not prevent it from examining the fact and significance of changes in Dr Lamming’s later evidence. Those changes were relevant not only to insight but also to propensity and trustworthiness. The Tribunal had to determine what had changed, why it had changed, and what effect that had on current fitness.

4. The Tribunal accepted that there were inconsistencies but did not identify or evaluate them. It failed to address differences concerning the date when Dr Lamming knew of the payments, whether he monitored his accounts, what he believed the payments represented, and his state of mind when explaining matters to his employer. It also failed to confront statements which appeared to minimise the seriousness of the earlier dishonesty and were inconsistent with an acceptance of it.

5. Although an appellate court may read reasons in the context of the evidence and submissions, the transcript could not cure the Tribunal’s failure to explain its conclusions. The reasons did not show how the alleged continuing dishonesty, lack of trustworthiness, minimisation and lack of insight had been assessed. They were therefore legally inadequate and demonstrated that the proper thought processes had not been undertaken.

• Medical Practitioners Tribunal — On 10 February 2017, directed restoration of Dr Lamming’s name to the register under section 41(1) of the Medical Act 1983.
• High Court (Administrative Court) — Allowed the GMC’s appeal, quashed the Tribunal’s decision and remitted the application to a differently constituted Tribunal under section 40A(6) of the Medical Act 1983.