General Medical Council v Varaha Vijaya Nageswara Appala Naidu Konathala

On an appeal concerning professional disciplinary sanction, the court may substitute its own decision only with caution and where confident that it is the correct outcome. Where there is room for reasonable disagreement, particularly if further evidence or submissions may be relevant, the proper course is remission to the specialist tribunal. Greater confidence in assessing sanction may be appropriate in cases of sexual misconduct. Erasure is proportionate where the misconduct, viewed against protection of patients and the public, public confidence, and proper professional standards, is fundamentally incompatible with continued registration.

The General Medical Council appealed against a Medical Practitioners Tribunal decision concerning the respondent doctor’s misconduct and fitness to practise. In an earlier judgment, the court allowed the appeal and invited further submissions on whether it should substitute erasure or remit sanction to the Tribunal.

The respondent relied on the Tribunal’s specialist expertise and on a subsequent finding that his fitness to practise was no longer impaired after suspension. The central issue was whether the court should determine the sanction itself under section 40A of the Medical Act 1983, or remit the matter for reconsideration.

1. Approach to substitution and remission. The power under section 40A(6)(c) of the Medical Act 1983 should be exercised with caution. The court should substitute its own decision only where confident that it is the correct outcome. If there is room for differences of opinion, particularly in light of further submissions or additional evidence, the appropriate course is remission under section 40A(6)(d). The Tribunal is a specialist regulatory and disciplinary body with expertise in assessing impairment, insight, remediation, risk of repetition and sanction.
2. That restraint is especially important where the misconduct concerns clinical practice. However, in sexual misconduct cases the court may have greater confidence in assessing the sanction necessary to protect the public and maintain the reputation of the medical profession, following General Medical Council v Jagjivan [2017] 1 WLR 4438.
3. Relevant sanction considerations. Sufficiency of sanction involves the health, safety and well-being of patients and the public, together with public confidence in the profession and the maintenance of proper professional standards and conduct.
4. Disposition. The respondent’s deliberate and opportunistic sexual assault on a patient, involving abuse of a position of trust and power for sexual gratification, was fundamentally incompatible with continued registration. Remission would serve no useful or proper purpose because erasure was the only reasonable and proportionate outcome. The court therefore substituted its own decision under section 40A(6)(c) and directed under section 35D(2)(a) of the Medical Act 1983 that the respondent’s name be erased from the register. Counsel were directed to agree the consequential order and the agreed costs position.

• High Court (Administrative Court): In General Medical Council v Konathala [2025] EWHC 1550 (Admin), the court allowed the appeal against the Tribunal’s decision and invited further submissions on sanction.
• High Court (Administrative Court): In the present judgment, the court declined to remit sanction and directed erasure under the Medical Act 1983.