The Professional Standard Authority for Health and Social Care v General Medical Council & Anor.

An appellate court reviewing a professional disciplinary sanction must respect the specialist tribunal’s evaluative judgment. It may intervene where there is an error of principle or the sanction falls outside the range of decisions reasonably open to the tribunal.

A serious procedural error also arises where the tribunal’s reasons are inadequate or unclear, so that the court cannot determine whether important matters were understood, how they affected seriousness and proportionality, or whether the sanction was sufficient for public protection. A tribunal must address the relevant sanctions guidance and give clear, substantial and specific reasons for departing from it. Where facts are admitted, the tribunal must nevertheless resolve material uncertainties, using questions where necessary, and expose its analysis in cogent reasons.

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 Professor Sundara Lingam.

The Tribunal had found misconduct and impaired fitness to practise arising from the signing and issuing of almost 300 private prescriptions without adequate patient information, examination, monitoring or follow-up. It imposed a 24-month conditions of practice order, with review before expiry.

The PSA challenged the sanction as insufficient for public protection and public confidence, and argued that the Tribunal’s reasoning was inadequate, including its treatment of seriousness, aggravating and mitigating factors, insight, remediation, proportionality and departure from the Sanctions Guidance. The central issue was whether the sanction decision could be reviewed and, if so, whether it was legally sustainable.

1. Disposition. The appeal was allowed. The conditions of practice decision was quashed and remitted to the Tribunal for reconsideration on the basis of serious procedural error caused by inadequate and unclear reasoning. The court did not determine that suspension was necessarily required.
2. Appellate approach. Under section 29, the court must dismiss an appeal if the penalty was correct, even if some underlying findings were inadequate. It may quash and substitute or remit where the penalty was wrong, or remit where serious procedural irregularity prevents determination of that question. The court must show restraint because the Tribunal has specialist expertise, but that restraint is reduced where procedural or reasoning failures are established.
3. Inadequate reasoning. The Tribunal did not explain whether it accepted Professor Lingam’s humanitarian explanation, how the risks created by the prescribing affected seriousness, or what significance it attached to the involvement of other doctors, his relationship with Kool Pharma and his role in introducing it to the hospital. Its reasoning did not adequately explain why conditions were proportionate despite limited evidence of insight or remediation and seven years of restricted practice.
4. Guidance and public protection. The Tribunal had to address the Sanctions Guidance and give clear reasons for any departure. Passage of time and compliance with interim conditions were relevant but did not displace the need to analyse seriousness, public safety, public confidence, professional standards, insight and remediation.
5. Tribunal’s inquisitorial duty. Where admitted facts leave central issues unclear, the Tribunal must investigate them where possible, including by questioning witnesses. Cogent reasons require the Tribunal to identify the principal issues, resolve material uncertainties and explain the significance of the evidence.

1. Medical Practitioners Tribunal: found misconduct and impaired fitness to practise, then imposed a 24-month conditions of practice order on 12 October 2022.
2. High Court (Administrative Court): allowed the statutory appeal under section 29 of the National Health Service Reform and Health Care Professions Act 2002, quashed the sanction decision and remitted the matter for reconsideration.