David Cook v General Medical Council

An appellate court reviewing an Interim Orders Tribunal must decide whether its decision was wrong, while giving appropriate weight to the specialist tribunal’s judgment. The weight required varies with the circumstances and may be reduced where the tribunal’s reasoning is inadequate or opaque.

An Interim Orders Tribunal must address the actual interim question. It must not determine disputed merits or credibility, but must consider the material circumstances relevant to whether suspension or conditions are necessary in the public interest. Where circumstances have materially changed, it must explain why an earlier, less restrictive order should no longer be followed. Failure to engage with central evidence and the distinction between proved and unproved allegations may make the decision wrong.

Dr David Cook challenged the Interim Orders Tribunal’s decision of 10 March 2023 maintaining his suspension from medical practice. The suspension had originally followed his arrest and subsequent criminal charges concerning online conversations about sexual offences involving children.

He was convicted of two obscene-publication offences and received a 12-month conditional discharge. The jury did not agree on two more serious counts, which were left on the file, and the prosecution indicated that it would not seek a retrial. Psychiatric evidence described severe depression and autism at the relevant time, with substantial improvement in his mental health.

The central issue was whether the Tribunal had lawfully and proportionately concluded that suspension, rather than conditions, remained necessary to protect public confidence while the GMC investigation continued.

1. The challenge succeeded. The Tribunal’s decision to maintain interim suspension was wrong. The court ordered that the suspension end at 11.59 hours on 17 August 2023.

2. The statutory appellate question was whether the Tribunal’s decision was wrong. That did not permit an unconstrained merits review. The court had to give appropriate weight to the specialist Tribunal, although the weight depended on the circumstances. Less weight may be appropriate where the issue concerns matters which the court can assess more readily, such as sexual misconduct and public confidence, or where the reasoning is inadequate or opaque.

3. An Interim Orders Tribunal must determine whether an interim order is necessary on the basis of the allegations and evidence before it. It must not decide disputed credibility or the substantive merits. It may, however, discount manifestly unreliable evidence and consider evidence showing that an allegation is manifestly unfounded or exaggerated.

4. The Tribunal’s reasoning focused on the possibility that the regulatory process might encompass the serious allegations of which the appellant had not been convicted. That approach failed to examine the issue in the round. The Tribunal did not adequately address the absence of convictions on those counts, the psychiatric evidence indicating that mental illness rather than a genuine sexual interest in children explained the behaviour, the appellant’s improved mental health, and the significance of the convictions and conditional discharge.

5. The Tribunal also failed to explain why conditions, imposed in June 2021, were no longer sufficient. The public interest in consistent decision-making required it at least to consider whether there was good reason to depart from the earlier conditions order. Its reference to the seriousness of the “charges” was also unclear because there were no extant criminal or regulatory charges at the time.

6. The court could not substitute conditions for suspension under section 41A(10) of the Medical Act 1983. It therefore fixed an earlier end date for the interim suspension so that the Tribunal could reconsider the appellant’s immediate position, with the benefit of a medical assessment.

The judgment does not identify a separate lower-court judgment. It concerns a statutory challenge to the Interim Orders Tribunal’s decision of 10 March 2023. The High Court found that decision wrong and ordered the interim suspension to end at 11.59 hours on 17 August 2023.