Professional Standards Authority for Health and Social Care v General Medical Council & Anor

On an appeal against a professional disciplinary sanction, the court must respect the tribunal’s evaluative expertise but may attach less weight to it where the misconduct does not concern clinical treatment or where the tribunal lacked the benefit of hearing the practitioner.

Sexually motivated, deliberate conduct involving an abuse of professional power and causing foreseeable harm may be fundamentally incompatible with continued registration. The absence of repetition is neutral without positive evidence that the incident was aberrational. Where the practitioner provides no evidence of insight, remorse or remediation, there may be no proper basis for concluding that repetition is unlikely. In such circumstances, erasure may be the only proportionate sanction.

The Professional Standards Authority appealed under section 29 of the National Health Service Reform and Health Care Professions Act 2002 against a Medical Practitioners Tribunal decision concerning Christian Hanson. The Tribunal found that he had engaged in sexually motivated, unwanted and non-consensual conduct towards a nurse and that his fitness to practise was impaired. It imposed a 10-month suspension with review.

The respondents did not participate in the appeal. The central issue was whether the Tribunal’s sanction was wrong under CPR rule 52.21(2)(a), and whether erasure was required to protect the public and maintain confidence in the medical profession.

1. Appeal allowed. The Tribunal’s sanction was wrong. The court substituted an order erasing Dr Hanson’s name from the medical register under section 29(7)(c) of the National Health Service Reform and Health Care Professions Act 2002.
2. The court approached sanction as an evaluative decision and accorded appropriate weight to the Tribunal’s expertise. That weight was reduced because the misconduct did not concern the treatment of patients and because Dr Hanson had not appeared before the Tribunal. The court could therefore assess more readily what was required to protect the profession’s reputation.
3. The misconduct was exceptionally serious. It involved a senior doctor deliberately isolating a less experienced nurse at night, repeated sexually motivated touching, persistence after she objected, an abuse of power and foreseeable real harm. If proved to the criminal standard, the conduct would have constituted sexual assault contrary to section 3 of the Sexual Offences Act 2003.
4. The absence of evidence of similar conduct before or after the incident was neutral, not mitigation. Nor was the incident’s description as single and short a genuine mitigating factor, given the deliberate and persistent nature of the conduct.
5. Insight was central. Although insight may be demonstrated in different ways even where misconduct is disputed, Dr Hanson’s complete non-engagement provided no evidence of insight, contrition or remediation. The Tribunal therefore lacked a proper basis for concluding that repetition was unlikely.
6. The conduct engaged paragraphs 109(a)–(d) of the GMC Sanctions Guidance and was fundamentally incompatible with continued registration. Suspension could have been appropriate only if strong mitigation supplied a proper basis for finding repetition unlikely. No such basis existed, and remittal was unnecessary because only erasure could properly be imposed.

• Medical Practitioners Tribunal: found misconduct and impairment of fitness to practise, imposing a 10-month suspension with review on 29 September 2020.
• High Court (Administrative Court): allowed the Professional Standards Authority’s appeal and substituted erasure under section 29(7)(c) of the National Health Service Reform and Health Care Professions Act 2002.