Blakely v The General Medical Council

At a fitness-to-practise review, a doctor cannot be required to admit misconduct that she continues to deny. The tribunal may nevertheless assess whether she understands why the conduct was unacceptable and whether it creates a risk of repetition. Insight may be shown by accepting, with hindsight, that the conduct was wrong, or by understanding why others would regard it as dishonest and damaging to public confidence. A tribunal must distinguish those questions from whether the doctor accepts the original factual findings. Appellate intervention in an evaluative decision is justified only for an error of principle or where the decision falls outside the range reasonably open to the tribunal. A further suspension may be imposed where inadequate insight leaves a risk to public confidence; its purpose is protective, not punitive.

The appellant, a doctor, appealed under section 40 of the Medical Act 1983 against a Medical Practitioners Tribunal decision made on review. Her fitness to practise had previously been found impaired by misconduct involving covert recordings of patients and knowingly misleading emails asserting that the GMC and CQC had advised or instructed her to make them. At review, the Tribunal found that she had not demonstrated sufficient insight and extended her suspension by nine months. The appeal challenged the fairness of questioning, the finding of continuing impairment, and the necessity and length of the further suspension. The central issues were whether denial of dishonesty could properly be considered and whether the further suspension was disproportionate.

Appeal dismissed. The Tribunal was entitled to find that the appellant’s fitness to practise remained impaired and to extend her suspension for nine months.

1. At a review, the original findings of fact are not reopened, and a registrant is entitled to maintain a denial of the conduct or of dishonesty. Admission of misconduct is not a condition precedent to demonstrating insight. The relevant question is whether the registrant understands the gravity of the conduct, why it was unacceptable, and how it could be avoided in future.
2. Insight may be demonstrated in different ways. The doctor may accept, with hindsight, that the conduct was wrong even if it was not perceived as dishonest at the time. Alternatively, the doctor may understand why members of the public would regard the conduct as dishonest and as undermining trust, even if the doctor maintains that it was excusable or not dishonest. A tribunal must keep that inquiry distinct from requiring an admission of guilt.
3. The questioning was not unfair. It properly focused on whether the appellant understood that stating to patients that the GMC had advised or instructed her to make the recordings was factually inaccurate and why knowingly making such statements would undermine public confidence. The Tribunal was entitled to conclude that her responses showed insufficient insight and a risk of repetition.
4. On sanction, the protective statutory objective includes maintaining public confidence in the profession and proper professional standards and conduct. The Tribunal considered proportionality, the appellant’s interests, her status as a well-regarded doctor, and the available sanctions. Its evaluative decision could be disturbed only for an error of principle or if it fell outside the bounds of what it could reasonably and properly decide. Those conditions were not met.
5. The further suspension was not punitive. The Tribunal was entitled to regard nine months as necessary to enable meaningful reflection and the production of evidence of insight. The fact that the further period exceeded the original six-month suspension did not make it disproportionate.

The appeal was dismissed in its entirety.

• Medical Practitioners Tribunal: On 19 November 2018, on review under the Medical Act 1983, determined that fitness to practise remained impaired and extended the suspension for nine months.
• High Court (Administrative Court): Appeal under section 40 dismissed. The Tribunal’s decision was upheld.