General Medical Council v Patel

An appeal under section 40A of the Medical Act 1983 is a true appeal, governed by the ordinary test of whether the tribunal’s decision was wrong. The appellate court must respect primary factual findings and the tribunal’s expertise, but may attach less weight to that expertise when assessing dishonesty and the protection of public confidence.

Sanctions are directed principally to public protection, public confidence and professional standards, rather than punishment. The practitioner’s personal and career consequences are relevant but have limited weight. Remediation, insight and low risk of repetition will rarely constitute exceptional circumstances justifying no action after serious, deliberate dishonesty, particularly where patients were placed at risk. The tribunal must explain clearly why any exceptional circumstances justify taking no action.

The General Medical Council appealed under section 40A(1)(d) of the Medical Act 1983 against a Medical Practitioners Tribunal decision dated 12 May 2017. The Tribunal had found that the respondent doctor had undertaken overlapping NHS and private locum commitments, made a false payment claim, and acted dishonestly and misleadingly. It found his fitness to practise impaired but imposed no sanction, relying on his remediation, insight, low risk of repetition and the potential effect of suspension on his specialist training and career.

The GMC contended that the Tribunal had misdirected itself about the evidence, placed excessive weight on career consequences and remediation, and failed to protect public confidence and professional standards. The central issue was whether the decision to take no action was wrong and insufficient for the protection of the public.

1. Appeal allowed. The Tribunal’s decision was quashed and the matter was remitted for reconsideration of sanction. The GMC was awarded costs summarily assessed at £12,954.50.
2. Proceedings under section 40A of the Medical Act 1983 are appeals, not rehearings or resentencing exercises. The appellant must establish that the Tribunal’s decision was wrong. The court may correct material errors of fact and law, but should be cautious before disturbing findings dependent on witness credibility. It should show diffidence towards the Tribunal’s professional expertise on impairment, seriousness, public confidence and sanction.
3. That restraint is reduced where the issue concerns dishonesty. The court is better placed to assess what is required to protect the public and maintain confidence in the profession. The statutory objectives include protecting the public, maintaining public confidence and maintaining proper professional standards.
4. The Tribunal materially misconstrued the evidence concerning the possible consequences of suspension for the doctor’s training number. The evidence did not establish that suspension would automatically remove the number or inevitably end the doctor’s career. The Tribunal therefore placed excessive weight on an assumed worst-case outcome.
5. The personal consequences of sanction are relevant but subordinate to the regulatory purpose. The Tribunal failed to apply the guidance in Bolton v The Law Society [1993] EWCA Civ 32, namely that the reputation and integrity of the profession may outweigh the fortunes of the individual member.
6. The Tribunal also gave excessive weight to remediation at the sanction stage. Remediation may be particularly important in clinical error or incompetence cases, but has less significance where the misconduct is non-clinical dishonesty. The deliberate conduct was for financial gain and created a risk that the doctor could be required to attend two places at once, thereby placing patients at risk.
7. The Tribunal’s favourable sanction-stage assessment of credibility was not reconciled with its earlier adverse findings. A change of view may be permissible, but it requires explanation. The absence of explanation was a further error in the reasoning.
8. The circumstances were not exceptional. Exceptional circumstances are unusual, special or uncommon, and cases justifying no action are likely to be very rare. The Tribunal failed to explain a sufficient basis on which its findings of insight, remediation, skill and professional esteem could outweigh the need to maintain public confidence and proper standards.
9. The finding of impairment alone did not provide a sufficient regulatory signal. In light of the Tribunal’s findings of repeated, premeditated dishonesty and risk to patients, the decision to take no action was insufficient for the protection of the public under section 40A(4).

• High Court (Administrative Court): allowed the GMC’s appeal against the Medical Practitioners Tribunal’s decision dated 12 May 2017 to take no action. The matter was remitted for reconsideration.