Dr Belinda Agoe & Anor v General Medical Council

The appellants, two general practitioners, appealed under section 40 of the Medical Act 1983 against Medical Practitioners Tribunal Service decisions that found their fitness to practise impaired by reason of misconduct and suspended their registration. The principal legal issues were whether the GMCs referral and the MPTS proceedings were tainted by unlawful direct race discrimination contrary to the Equality Act 2010 (notably ss 13, 23 and 53 and the evidential provision s 136), whether the Tribunals factual findings were inconsistent or inadequately reasoned, and whether the sanctions (suspensions) were disproportionate and irrational.

The court declined to decide the res judicata point definitively but considered the discrimination and factual grounds on their merits. The MPTS abuse of process decision was held to be lawful: there was no evidence that GMC decision-makers knew the comparators ethnicity, the appellants did not discharge the first-stage burden under section 136 EA 2010, and the Tribunal was entitled to conclude that Dr Strommer was not a proper comparator. The challenges to factual findings and reasons failed: the Tribunal had sufficient evidence and gave adequate reasons. Finally, the suspensions (two and three months) were within the range of reasonable responses to serious misconduct and the Tribunal properly considered mitigation and aggravation. The appeal was dismissed.

This appeal arises from MPTS fitness to practise proceedings which found that the appellants obstructed a handover of GP services at a medical centre after the practices CQC registration was suspended. The GMC alleged that between 1 and 6 November 2018 the appellants prevented the incoming caretaker provider from taking over, delivered patient services themselves and thereby breached the suspension. The MPTS found most allegations proved, found impairment by reason of misconduct, and imposed suspensions (three months for the first appellant; two months for the second).

Procedural background:

• The events were the subject of a First-tier Tribunal decision: Staunton Group Practice v Care Quality Commission [2019] UKFTT 0070 (HESC), which found serious regulatory failings and supported the need for urgent cancellation of registration.
• The appellants faced interim orders and earlier High Court decisions (including Dr Belinda Agoe & Dr Kausar Ali v General Medical Council [2020] EWHC 39 (Admin)) dealing with interim suspension orders.
• The appellants sought judicial review of the GMCs investigation decisions; a later permission-stage challenge was refused on the papers (Deputy Judge Paul Bowen KC, 11 October 2023) and was then withdrawn.
• They then appealed the MPTS decisions under section 40 of the Medical Act 1983; their grounds grouped into (i) race discrimination/abuse of process (grounds 15), (ii) alleged inconsistent/unreasoned factual findings (ground 6), and (iii) challenge to sanctions (grounds 78).

Issues framed by the court:

• Whether the MPTS should have stayed proceedings as an abuse of process because the GMCs referral and investigation were alleged to be racially discriminatory.
• Whether the MPTS applied the correct evidential approach under section 136 Equality Act 2010 (the two-stage approach: prima facie case then respondents explanation) and whether the Tribunals factual findings and reasons were adequate.
• Whether suspension rather than conditions of practice was a proportionate sanction, and whether different durations for the two appellants were rationally justified.

Courts reasoning and conclusions:

• The court declined to resolve definitively whether prior judicial review proceedings created res judicata or estoppel; however, on the merits it rejected the appellants discrimination complaints. The MPTS had been entitled to accept the GMCs unchallenged statement that decision-makers were unaware of the comparators ethnicity; absent evidence of knowledge, the appellants could not make the requisite prima facie case under s 136 EA 2010. The Tribunal properly treated Dr Strommer as an unsuitable comparator given differences in conduct and involvement.
• The Tribunal had considered the correct legal approach (the two-stage test) and its reasoning, though capable of clearer phrasing in places, was adequate when read as a whole.
• Factual challenges failed. The Tribunals findings that the appellants obstructed handover, organised or delivered services and were warned about unlawfulness were supported by evidence (including contemporaneous correspondence and the earlier FTT findings) and its reasoning was adequate.
• On sanction, the Tribunal correctly applied guidance, considered aggravating and mitigating factors, and reasonably concluded that suspension was necessary to protect patients and public confidence. The differing lengths reflected differences in proven conduct.

Relief sought and disposition: The appellants sought quashing and remittal to a differently constituted tribunal. The court dismissed the appeal and upheld the MPTS decisions.

The appeal is dismissed. The High Court held that the MPTS abuse of process decision and factual findings were lawful and adequately reasoned. There was no evidential basis to conclude that the GMC had discriminated on grounds of race because the appellants failed to establish the necessary prima facie case under section 136 of the Equality Act 2010 and the Tribunal was entitled to treat the comparator as unlike the appellants. The sanctions (suspensions) were within the range of reasonable and proportionate responses to the proven misconduct.

This is an appeal under section 40 of the Medical Act 1983 from MPTS decisions (facts determined November 2023; sanctions determined 8 March 2024) which suspended each appellant. The factual and regulatory background included the First-tier Tribunal decision Staunton Group Practice v Care Quality Commission [2019] UKFTT 0070 (HESC) and earlier High Court proceedings including Dr Belinda Agoe & Dr Kausar Ali v General Medical Council [2020] EWHC 39 (Admin). The appellants pursued two distinct sets of judicial review proceedings in the Administrative Court in relation to investigation and abuse of process issues; permission was refused at interlocutory stages and a renewal was later withdrawn.