Dr David Cook v General Medical Council

The High Court’s jurisdiction under section 41A(10) of the Medical Act 1983 is original, not judicial-review jurisdiction. The court must decide whether the extant interim conditions are wrong, giving appropriate weight to the specialist tribunal while considering all the evidence then available.

Interim conditions may be imposed to address either a real risk to public safety or adverse effects on the public interest and the doctor’s interests. The latter basis does not require proof of a real risk to a patient. Conditions must remain proportionate, and their effectiveness may justify continuity requirements. Light-touch clinical supervision and a minimum locum period were proportionate where workplace stress could precipitate relapse and supervision required continuity.

Dr David Cook, a senior respiratory consultant, applied under section 41A(10) of the Medical Act 1983 to revoke two conditions imposed by the Interim Orders Tribunal. The conditions required light-touch clinical supervision and prohibited locum or fixed-term posts lasting less than eight weeks.

The conditions followed Dr Cook’s criminal convictions for publishing and attempting to publish obscene material concerning the sexual abuse of children. Two psychiatric assessments identified recurrent depressive illness, vulnerability to relapse and the significance of workplace stress. The Tribunal maintained the conditions on review in March 2024.

The central issues were whether the conditions were justified under the public-interest and doctor-interest basis for interim restrictions, whether they were proportionate, and whether the eight-week minimum was necessary to make supervision effective.

1. Jurisdiction and approach. The application was not a judicial review. Section 41A(10) conferred original powers to vary or revoke conditions. The court had to determine whether the extant March 2024 order was wrong, respecting the Tribunal’s specialist judgment but deciding the appropriate order on the evidence before the court. Superseded earlier orders were not to be retrospectively quashed.
2. Applicable statutory basis. The guidance identified two alternative bases for interim restrictions: impairment presenting a real risk to members of the public, and impairment that might adversely affect the public interest or the doctor’s interests. The challenged conditions were imposed on the second basis. That basis did not require the Tribunal to identify a real risk to public safety.
3. Clinical supervision. The Tribunal was entitled to rely on the positive recommendation of Dr Reiss. Dr Deshpande’s silence did not amount to a contrary conclusion. The relevant concern was not deskilling or proven clinical incompetence, but recurrent depression, vulnerability to relapse and the connection between relapse and workplace stress. Light-touch supervision provided professional support and an early-warning mechanism for deterioration affecting clinical performance. It was rationally connected to the legitimate public-interest and doctor-interest objectives.
4. Proportionality. The conditions had to impose no more interference with practice than necessary. The lightest level of supervision struck a fair balance between the doctor’s interest in working and earning a living, the public interest and the need for professional support. Proportionality was assessed both individually and across the package.
5. Locum duration. A minimum eight-week locum period was necessary to preserve continuity. Repeated short placements could prevent a supervisor from assessing performance and would materially undermine the effectiveness of fortnightly supervision. The restriction was therefore proportionate and did not amount to a de facto suspension.
6. Disposition. The Tribunal’s decision to impose and maintain both conditions was not wrong. The application was dismissed.

• High Court (Administrative Court): Lane J directed that the interim suspension should terminate on 17 August 2023: [2023] EWHC 1906 (Admin). The Interim Orders Tribunal then imposed conditions.
• High Court (Administrative Court): the present court dismissed the application to revoke the two conditions.