Dr Reeta Singh v General Medical Council

On a statutory appeal under section 40 of the Medical Act 1983, the court may rehear the issue of current impairment and substitute its own assessment where the tribunal’s conclusion was wrong. Misconduct and impairment remain distinct. Serious past administrative failings do not necessarily establish current impairment, particularly where there was no dishonesty, no effect on clinical competence or patient safety, genuine insight and remediation, a very low risk of repetition, and an available warning mechanism. Public confidence and professional standards must be assessed in the circumstances of the particular case. The need to mark misconduct or impose a penalty must not drive the finding of impairment.

Dr Reeta Singh appealed under section 40 of the Medical Act 1983 against a Medical Practitioners Tribunal determination that her fitness to practise was impaired by misconduct and its consequent one-month suspension. The underlying findings were accepted: between 2011 and 2015 she failed to ensure proper administration of staff pension contributions at a GP practice, despite becoming aware of persistent problems. The Tribunal found serious misconduct, but also found no dishonesty, no patient-safety impact, genuine insight, remediation, apologies and a very low risk of repetition. The sole issue was whether current impairment had been established.

1. The appeal was a rehearing, not a review. Applying Sastry v GMC, the court was not required to defer to the Tribunal beyond what the circumstances warranted and could substitute its own decision. The court was well placed to assess public protection, public confidence and professional standards because the misconduct was administrative rather than clinical.

2. Misconduct and impairment were separate concepts. A finding of misconduct did not inevitably entail current impairment. The Grant test was a useful guideline, not a prescriptive checklist. None of its limbs concerning patient risk, bringing the profession into disrepute, breach of a fundamental professional tenet or dishonesty was established.

3. The only possible basis was the public interest. The prolonged pension failures and their potential effect on a small number of employees did not show that public confidence or professional standards required an impairment finding. The misconduct did not affect Dr Singh’s clinical abilities, had not been repeated, was unlikely to recur, and had been met with genuine insight, remorse and full financial remediation.

4. Insight and remediation were important in administrative as well as clinical cases. There was no rule that insight acquired later carried less weight. The GMC’s power to issue a warning was a relevant alternative means of marking disapproval. A perceived need for punishment or deterrence could not determine impairment.

5. The finding of impairment and the suspension were set aside. The matter was to be dealt with by a GMC warning, with the parties first to agree its wording and any disagreement to be resolved on paper.

• High Court (Administrative Court): appeal under section 40 of the Medical Act 1983 allowed. The Tribunal’s finding of current impairment and one-month suspension were set aside, and a warning was substituted.