Onwude v General Medical Council

A doctor’s treatment of a person with whom he has a close personal relationship is not automatically wrongful or serious professional misconduct. The issue depends on the circumstances, including whether the relationship risked impairing professional objectivity or patient safety. A tribunal must give adequate reasons for findings of dishonesty and an intention to cause distress. A finding that a doctor changed his mind and later invoiced patients after originally intending not to charge did not, on the evidence, establish dishonesty. Deficiencies in record-keeping and communication with another general practitioner may amount to professional breaches, but their seriousness and appropriate sanction require separate assessment.

The appellant, a consultant gynaecologist, appealed against a Medical Practitioners Tribunal decision finding several allegations of serious professional misconduct proved and ordering erasure. The allegations arose from his treatment and prescribing for two friends, Patients A and B, his subsequent invoices after the breakdown of a related business relationship, failures concerning records and communication with general practitioners, and a period without professional insurance.

The central issues were whether the findings of dishonesty, an intention to cause distress, treatment of close friends, practice outside professional competence, record-keeping and communication failures were justified, and whether erasure was lawful.

1. Appeal and procedural fairness. The appeal was allowed and the tribunal’s decision was quashed. The legal assessor had wrongly upheld Patient B’s reliance on a confidentiality agreement when the agreement permitted disclosure to regulatory bodies, including the GMC. That error deprived the appellant of potentially relevant evidence concerning the invoices, his honesty and his alleged intention to cause distress.
2. Dishonesty and distress. The tribunal’s findings that the appellant had acted dishonestly and intended to cause distress were findings which no reasonable tribunal could have made on the evidence. The patients understood that he was not initially charging for the treatment. Sending invoices later, in the context of winding up a business relationship, might have been unpleasant or have raised civil issues, but did not establish dishonesty. The tribunal gave inadequate reasons for its finding of an intention to cause distress. Those allegations could not be revived on remission.
3. Treatment of close personal friends. Guidance stating that doctors should, wherever possible, avoid treating persons with whom they have a close personal relationship did not create an absolute prohibition. The court rejected the broader approach attributed to Hussein v The General Medical Council [2013] EWHC 3535 (Admin). The question was whether, in the circumstances, the relationship created a risk that objectivity would be impaired or that the patient would be placed at risk. Mere treatment of a close friend did not establish serious professional misconduct.
4. Other allegations. The tribunal was entitled to find inadequate contemporaneous records and, in relation to the private general practitioner, a failure to communicate treatment where the absence of records made that information more important. The allegation concerning notification of the NHS general practitioner was unsustainable because the patients were not attending that practitioner. Providing primary care without being on the general practitioner register might technically have breached the relevant obligation, but was, on the facts, a technical matter requiring separate consideration of seriousness and sanction.
5. Remission and orders. The remaining matters, particularly the alleged period of practising without insurance, were remitted for reconsideration of whether they amounted to serious professional misconduct and, if so, the appropriate sanction. The serious allegations could not be resurrected. The appellant’s immediate suspension came to an end. Costs were to be addressed by written submissions.

The judgment states that the appeal was brought from the Medical Practitioners Tribunal’s decision of 15 December 2016. The tribunal had found several charges proved and imposed erasure. The High Court allowed the appeal, quashed that decision and remitted the surviving matters for reconsideration.