Dr Mohammad Adil v General Medical Council

On an appeal under section 40 of the Medical Act 1983, the court must independently decide whether a disciplinary sanction was appropriate and necessary in the public interest, while giving appropriate deference to the tribunal.

On a review, the tribunal must consider whether the concerns underlying the original impairment finding have been sufficiently addressed. A tribunal must consider relevant mitigation, including past record, continuing professional development and personal circumstances. Those matters remain subordinate to the need to maintain public confidence in the profession.

Erasure may be proportionate where serious professional misconduct is repeated, the practitioner lacks insight and remediation, and the conduct objectively damages public confidence, even without evidence of harm to identified patients.

The appellant, a locum consultant colorectal surgeon, appealed against a Medical Practitioners Tribunal decision directing erasure of his name from the Medical Register.

The erasure decision followed a review of an earlier six-month suspension imposed for misconduct involving repeated public statements about Covid-19, vaccination and related matters. The Tribunal found continuing impairment, repetition, lack of insight and failure to remediate.

The appeal proceeded on the ground that erasure was disproportionate, including by reference to freedom of expression, the absence of demonstrated patient harm, the absence of previous misconduct findings and alleged failure to consider mitigation. The court also determined an application to admit evidence not placed before the Tribunal.

1. The appeal was dismissed. The court held that an appeal under section 40 of the Medical Act 1983 is appellate rather than supervisory. The court must decide whether the sanction was appropriate and necessary in the public interest, or excessive and disproportionate, while giving appropriate deference to the Tribunal.

2. Because the decision followed a review, the Tribunal had to consider whether the concerns underlying the original impairment finding had been sufficiently addressed. The Appellant had been given an opportunity to demonstrate insight and remediation, but continued to justify the earlier conduct, repeated it and showed no meaningful insight.

3. The application to admit additional evidence was refused. Evidence available before the review hearing could have been obtained with reasonable diligence. Later material was merely an update to matters already available and was not capable of having an important influence on the outcome. The principles in Ladd v Marshall were applied alongside the overriding objective in the Civil Procedure Rules 1998.

4. The Tribunal was entitled to assess objectively, using its expertise, whether the conduct undermined public confidence. Evidence of harm to specific members of the public, or of actual loss of confidence by identified individuals, was unnecessary.

5. The Tribunal erred in stating that it had identified no mitigating factors. It should have considered the Appellant’s professional record, continuing professional development, future contribution to the NHS and personal and financial circumstances. That error did not make the decision wrong because those matters did not address the essential need to maintain public confidence or demonstrate that the original impairment concerns had been resolved.

6. The earlier finding that the statements were baseless and dangerous, combined with repetition, total lack of insight and absence of remediation, made erasure appropriate and necessary in the public interest. The sanction was also not disproportionate under Article 10 of the Convention.

• High Court (Administrative Court): The appeal against the September 2023 erasure decision was dismissed.
• High Court (Administrative Court): An earlier appeal against the 2022 findings and six-month suspension was dismissed: [2023] EWHC 797 (Admin).
• Court of Appeal: The earlier High Court decision was affirmed: [2023] EWCA Civ 1261.