Dr Sarah Alam v General Medical Council

An appellate court reviewing findings of dishonesty by a specialist professional tribunal must respect the tribunal’s factual advantage, but may intervene where its evaluation involved an error of principle or fell outside the range of reasonable decisions.

Where a tribunal finds that some closely related records were honestly made and others dishonestly made, it must stand back from the detail and assess the overall coherence and probability of its conclusions. Relevant good character evidence must also be taken into account where it bears materially on whether dishonesty or mistake is more likely.

The burden remains on the regulator to prove dishonesty on the balance of probabilities. The question is whether the practitioner genuinely believed the entry was accurate, not whether that belief was certain or guaranteed.

Dr Sarah Alam appealed under section 40 of the Medical Act 1983 against a Medical Practitioners Tribunal determination dated 8 April 2025. The Tribunal found that she had dishonestly made retrospective entries concerning invitations to chronic-disease reviews for 14 patients and consequently found impairment of fitness to practise and imposed a three-month suspension.

The appeal challenged the Tribunal’s failure to consider the overall consistency of its findings and alleged that it had reversed the burden of proof by relying on an absence of evidence establishing a genuine belief. The General Medical Council contended that the appellate court should be slow to interfere with findings by an expert tribunal which had heard the evidence.

1. Appeal allowed. The findings of dishonesty, the consequential finding of impairment and the three-month suspension were quashed. Ground 1 was sufficient to determine the appeal. Ground 2 was not strictly necessary, but the court accepted it.

2. Under Civil Procedure Rules 1998, rule 52.21, an appellate court may interfere where the lower decision was wrong or unjust because of serious procedural or other irregularity. The court must ordinarily be slow to disturb primary factual findings, particularly those involving credibility. That caution applies with particular force to a specialist tribunal.

3. However, an evaluative decision may be reviewed where the tribunal applied an erroneous principle or reached a conclusion outside the bounds of what it could properly and reasonably decide. The appellate court was therefore entitled to examine whether the Tribunal’s evaluation of the dishonesty allegations was legally sound.

4. The Tribunal erred by considering the individual patient entries in isolation and failing to take an overview. It accepted that many entries made during the same pressured exercise were honest, yet did not assess the probability or coherence of Dr Alam switching between honest and dishonest states of mind within very short periods.

5. The Tribunal also failed to take Dr Alam’s good character properly into account. Her character evidence was particularly relevant to whether the disputed entries were dishonest or honest mistakes. The absence of any reference to that factor in the determination meant that the court could not infer that it had been properly considered.

6. The Tribunal’s reasoning on the burden of proof was also flawed. The issue was whether Dr Alam genuinely believed that an invitation had been given, not whether she could be confident that it had been given or whether staff conduct could be guaranteed. The absence of a genuine belief was for the GMC to prove on the balance of probabilities. Treating the practitioner as receiving the benefit of the doubt only on one occasion suggested that doubt had not been resolved consistently in her favour.

7. Any consequential matters were to be addressed by written submissions and an agreed draft order filed within 14 days of hand down.

• Medical Practitioners Tribunal: On 8 April 2025, found dishonesty in relation to retrospective entries concerning 14 patients, found impairment of fitness to practise and imposed a three-month suspension.
• High Court (Administrative Court): Allowed the appeal under section 40 of the Medical Act 1983 and quashed the relevant findings and sanction.