SEKINAT BAKARE v GENERAL MEDICAL COUNCIL

A section 40 appeal against a Medical Practitioners Tribunal sanction is a rehearing. The court may substitute its own decision, while giving appropriate respect to the tribunal’s expertise. The question is whether the sanction was wrong and whether it was appropriate and necessary in the public interest, rather than excessive or disproportionate.

Serious dishonesty by a doctor may justify erasure even without direct patient harm. Dishonesty is particularly serious where it affects medical employment, involves abuse of professional trust, is persistent, is covered up, or is combined with limited insight and remediation. Personal mitigation and the absence of clinical risk may carry limited weight where erasure is required to maintain public confidence and professional standards.

The claimant, a doctor, appealed under section 40 of the Medical Act 1983 against a Medical Practitioners Tribunal decision directing that her name be erased from the medical register.

The tribunal had found two material courses of dishonesty. The claimant had repeatedly failed to disclose an ongoing fitness to practise investigation when applying for medical employment. She had also used a prescription pad retained from a former supervisor, forged the supervisor’s initials, and later misled the police. The tribunal found current impairment and concluded that the misconduct was fundamentally incompatible with continued registration.

The central issues were whether the sanction was wrong or disproportionate, whether the tribunal had given adequate reasons, and whether it had sufficiently considered mitigation, health difficulties, context, insight and remediation.

1. Appeal dismissed. The claimant had not shown that erasure was wrong. The sanction was appropriate and necessary in the public interest and was neither excessive nor disproportionate. The GMC was awarded costs of £8,854.55.

2. A section 40 appeal under the Medical Act 1983 is appellate and proceeds by way of rehearing. Under section 40(7), the court may dismiss the appeal, quash or substitute the sanction, or remit the case. The court may substitute its own decision, although it must accord appropriate respect to the tribunal’s judgment. The governing question was whether the sanction was wrong and whether it was appropriate and necessary in the public interest, rather than excessive or disproportionate.

3. The tribunal’s reasons were adequate. It identified two separate and serious courses of dishonesty, their persistence and cover-up, the claimant’s late admissions, and the limited evidence of insight and remediation. Those reasons enabled the parties to understand why the tribunal selected erasure rather than suspension.

4. The false employment declarations potentially engaged patient safety because concealing an investigation could expose patients to a doctor who might not be fit to practise. They also undermined confidence in the regulatory and medical employment systems. The prescription misconduct involved abuse of professional trust, forgery, prescribing without access to the patient’s full medical history, and subsequent misleading of the police.

5. Dishonesty lies at the highest end of professional misconduct. Erasure may be appropriate even where the conduct is outside direct clinical care. Where serious dishonesty is persistent or covered up and is combined with a lack of insight or remediation, suspension may be inadequate. The claimant’s health problems, testimonials, career impact, absence of repetition and remorse were considered, but personal mitigation carried limited weight against the seriousness of the misconduct and the need to protect the profession’s reputation.

• Medical Practitioners Tribunal: found current impairment and directed erasure from the medical register.
• High Court (Administrative Court): dismissed the section 40 appeal and upheld the sanction of erasure.