Aliu v General Medical Council (Rev 1)

On an appeal under section 40 of the Medical Act 1983, the court asks whether the tribunal’s decision was wrong or unjust because of serious procedural or other irregularity. The specialist tribunal’s factual findings and professional judgments attract substantial respect, particularly where it heard the evidence and applied clinical expertise. An appellant’s disagreement with an assessment, without an appealable error, is insufficient. A performance assessment need not invariably include recordings, a site visit, observation of practice or records review. The appropriate assessment instruments are matters for the assessors’ judgment. Where serious deficiencies, inadequate insight and absence of remediation mean that conditions cannot protect the public, erasure may be proportionate notwithstanding a previous interim suspension.

A Medical Practitioners Tribunal found that Dr Udo Musa Aliu’s fitness to practise was impaired by deficient professional performance following a performance assessment. It directed erasure from the medical register and imposed an immediate suspension pending appeal. Dr Aliu appealed as of right under section 40 of the Medical Act 1983, challenging the assessment’s fairness, methodology, integrity and accuracy, the findings of impairment, and the proportionality of erasure.

The central issues were whether the Tribunal’s decision was wrong or unjust because of serious procedural or other irregularity, and whether the sanction was excessive.

1. Appeal dismissed. The Tribunal’s findings of deficient professional performance, impairment and erasure disclosed no appealable error.
2. Under section 40 of the Medical Act 1983 and CPR rule 52.21(3), the court may intervene where the decision is wrong or unjust because of serious procedural or other irregularity. The approach in Meadow v General Medical Council [2007] QB 462, as summarised and applied in GMC v Jagjivan [2017] EWHC 1247 (Admin), requires respect for the specialist tribunal, its assessment of witnesses and its professional judgment. The appellate court remains cautious about disturbing primary factual findings and diffident about clinical and regulatory judgments.
3. The Tribunal carefully considered Dr Aliu’s allegations concerning the assessment process, including the absence of audio or video recordings, the duration and structure of the assessment, alleged collusion or fabrication, and the absence of site visits, records review and observation in clinical practice. It was entitled to accept the assessors’ evidence and to find them honest, credible and fair.
4. The law did not require the allegations to be proved by audio or video evidence. Nor did a performance assessment invariably require a site visit or records review. The assessors were entitled to select appropriate assessment instruments and had increased the number of OSCE stations to provide a fair sample of the claimant’s work.
5. The Tribunal was entitled to find that the assessment demonstrated serious risks to patients, including unsafe clinical responses, and that Dr Aliu lacked insight into his deficiencies. The court could not re-evaluate those clinical judgments merely because the claimant disagreed with them.
6. Although remediation was possible in principle, the breadth and depth of the deficiencies, combined with the persistent lack of insight and absence of remediation, meant that no conditions could adequately protect the public. Interim suspension did not justify a lesser substantive sanction. Erasure was therefore proportionate and necessary to protect the public and uphold confidence and standards in the profession.

The appeal was dismissed. Challenges to earlier High Court costs orders were not matters for this court.

• Medical Practitioners Tribunal: found deficient professional performance, impairment of fitness to practise and directed erasure from the medical register on 20 August 2020.
• High Court (Administrative Court): dismissed the section 40 appeal and upheld the Tribunal’s decision: [2021] EWHC 434 (Admin).