General Medical Council v Sledzik

On an appeal under section 40A of the Medical Act 1983, the court applies the ordinary appellate test. It may correct material errors of fact or law, but should show particular caution before disturbing primary factual findings or specialist regulatory assessments. A tribunal must give adequate reasons for its findings and sanction.

Where impairment findings disclose limited insight and absent remediation, those matters must be addressed coherently when sanction is determined. They do not automatically require erasure. The tribunal must apply proportionality, consider sanctions from least to most restrictive, and decide whether workable conditions can protect the public. If the sanction decision is flawed but erasure is not the only proper outcome, the appropriate remedy may be remittal for reconsideration.

The General Medical Council appealed under section 40A of the Medical Act 1983 against a Medical Practitioners Tribunal decision imposing conditions on the registration of an ophthalmic practitioner. The Tribunal had found extensive deficient professional performance and misconduct, current impairment, limited insight and a significant risk of repetition, but concluded that supervised retraining and conditions could protect the public.

The GMC argued that the Tribunal had failed to give effect to its impairment findings, had assessed mitigation and aggravation inconsistently, and should have imposed erasure. The central issues were whether the sanction reasoning was adequately explained and whether conditional registration was legally impermissible or insufficient on the findings made.

1. Appeal allowed in part and remitted. The Tribunal’s findings on impairment were not challenged and could not be reopened. The appeal succeeded because the sanction determination contained unexplained inconsistencies and inadequate reasons, but the court declined to substitute erasure. The case was remitted to the same Tribunal to redetermine sanction and provide full reasons.
2. The applicable approach to a section 40A appeal was that summarised in General Medical Council v Jagjivan & Anor [2017] EWHC 1247 (Admin). The proceedings were appeals governed by CPR Part 52. The court could correct material errors of fact and law, but had to be especially cautious about disturbing primary factual findings and had to approach specialist regulatory assessments with diffidence.
3. The Tribunal’s strong findings of limited insight, lack of remediation and risk of repetition were difficult to reconcile with its later finding that the practitioner’s insight was developing and that he could achieve satisfactory remediation. The Tribunal had not explained the change, and the evidence at sanction stage was limited. It was entitled to recognise positive employment evidence and a significant number of admissions, but it had to explain its treatment of aggravating factors.
4. Lack of insight was a potential aggravating factor under the Sanctions guidance, and the Tribunal had not explained why it confined that factor to the treatment of one patient. Failure to remediate and patient safety were not automatically aggravating factors, although exceptional facts might make either so striking that it would be wrong to omit it.
5. Conditional registration was not necessarily inconsistent with the impairment findings. The Sanctions guidance required a proportionate approach, considering sanctions in sequence from the least restrictive. Conditions could be appropriate where they were workable, measurable and capable of protecting the public. Erasure was not the only proper outcome merely because the allegations were serious, particularly where the practitioner was established, qualified, had no previous adverse disciplinary findings and could improve under supervision.
6. Insight and remediation remained essential to workable and effective conditions, especially where the practitioner worked independently and full co-operation was required. The Tribunal therefore had to reconsider sanction in the light of those matters. The parties were ordered to bear their own costs because the GMC established flaws in the determination but did not establish that conditional registration was insufficient or that erasure should be substituted.

• Medical Practitioners Tribunal: On 31 May 2018, imposed conditions on the respondent’s registration after finding misconduct, deficient professional performance and current impairment.
• High Court (Administrative Court): Allowed the GMC’s appeal to the extent that the sanction determination was flawed, declined to substitute erasure, and remitted sanction to the same Tribunal. The impairment findings remained undisturbed.