Dr Marwa Karmakar, R (on the application of) & Anor v The Royal College of General Practitioners

A body exercising powers under a Royal Charter may adopt bright-line eligibility criteria and is not subject to a freestanding common-law rule against fettering a non-statutory discretion. The criteria remain subject to rationality and statutory equality duties.

A policy which refuses even to consider further examination attempts, or to discount attempts taken before a disability was diagnosed, must have a coherent and reasoned basis. Treating candidates differently solely according to when they discover a disability was irrational where the examination body provided no adequate justification. Judicial review was an appropriate remedy, including where quashing the policy was sought.

Dr Marwa Karmakar, a GP trainee, challenged the Royal College of General Practitioners’ refusal to disregard three unsuccessful Applied Knowledge Test attempts taken before her neurodiversity was diagnosed, or to permit a further attempt. The British Medical Association brought a separate, broader challenge to the policy as it applied to the AKT and Recorded Consultation Assessment.

The claimants alleged unlawful fettering of discretion, irrationality, breach of the public sector equality duty, failure to make reasonable adjustments and indirect discrimination. The court also considered academic judgment, delay and whether judicial review was an appropriate remedy.

1. Justiciability and remedy. The dispute did not concern academic judgment. The College provided no evidence identifying academic expertise or analysis supporting its attempt limits. Judicial review was also the most convenient, expeditious and effective remedy. The Equality Act 2010 preserved judicial review notwithstanding the jurisdiction of the Employment Tribunal.
2. Delay. Dr Karmakar’s claim was in time, and the grant of permission prevented the College reopening promptness without an application to set that permission aside. In any event, she reasonably followed the College’s suggested exceptional fifth-attempt route before litigating. The BMA’s abstract challenge was out of time. Its knowledge of the policy and of affected individuals required earlier action, and time was not extended.
3. Fettering. The College’s powers derived from its Royal Charter and were not statutory or residual common-law powers. It could therefore adopt bright-line criteria without a freestanding obligation to retain exceptions. It remained subject to rationality and the Equality Act 2010.
4. Rationality. Limiting examination attempts was rational in principle, but the particular rule was not. The College had power to permit further attempts, yet presented its position as absolute. Its asserted reasons, including patient safety, GMC expectations, training limits and NHS funding, did not justify refusing any flexibility for candidates diagnosed after earlier attempts. The rule irrationally treated disabled candidates differently according to when they discovered their disability.
5. Equality Act grounds. The public sector equality duty was not breached. The reasonable-adjustment claim failed because the identified PCP was incapable of applying to disabled and non-disabled candidates alike, and the statutory knowledge provisions also applied. The indirect-discrimination claim failed for the same PCP reason.
6. Orders. Dr Karmakar’s claim succeeded. The decision of 11 January 2023 and the rule concerning AKT resits were quashed. The BMA’s application for permission was dismissed. Further submissions were required on whether the quashing of the AKT rule should operate retrospectively or prospectively.