British Medical Association, R (on the application of) v General Medical Council

A professional regulator may apply common professional standards to different regulated professions where the statutory scheme gives it a broad discretion and the decision is directed to public protection. The Padfield principle concerns the decision-maker’s statutory purpose, not whether the chosen means achieve that purpose optimally. A policy is unlawful for its treatment of the law only where it positively authorises or approves unlawful conduct, including by making a wrong positive statement of law or presenting a materially misleading account. Rationality review separately examines the reasoning process and whether the outcome falls outside the range of reasonable decisions.

The British Medical Association sought judicial review of the General Medical Council’s decision to apply Good Medical Practice to doctors, physician associates and anaesthesia associates, and to use “medical professionals” as a collective descriptor. It argued that the terminology conflicted with the statutory distinction between doctors and associates, that common standards frustrated the statutory objective of public protection, and that the decisions were irrational.

The GMC relied on extensive consultation, the overlap in clinical work, and its view that common high professional standards would promote patient safety. The claim was issued after the relevant decisions and the BMA sought an extension of time.

1. Ground one dismissed. The test in R(A) v Secretary of State for the Home Department is exhaustive for a challenge alleging that a policy misstates or omits the law. The question is whether the policy positively authorises or approves unlawful conduct. The term “medical professional” is not defined or protected by the Medical Act 1983. Its use therefore is not a statement of law which induces an associate to breach a legal obligation. Read as a whole, Good Medical Practice identifies the three professions and requires each person to be honest about qualifications and role.
2. Ground two dismissed. The statutory purpose was protection of the public through the objectives in section 1 of the Medical Act 1983. The GMC exercised its discretion for that purpose after consultation and research. The Padfield principle prevents collateral or purpose-defeating action, but does not permit the court to quash a decision merely because the court considers that it may fail to achieve, or could better achieve, the statutory objective.
3. The use of common standards was rationally connected with public protection. Associates undertake medical duties, work within multidisciplinary teams and require appropriate supervision. The use of “medical professionals” as a limited shorthand for the three regulated professions was not unlawful.
4. Ground three dismissed. Rationality review covers both process and outcome. The BMA identified no omitted mandatory consideration, irrelevant consideration, logical error or critical gap. Nor was the outcome outside the range of reasonable decisions open to the GMC.
5. The relevant decision was made on 27 April 2023. There was no adequate explanation for the delay in bringing the claim, and the wider concerns about associates did not establish sufficient public interest to justify an extension. Permission was granted, but the claim was dismissed and the extension of time refused.

First-instance judicial review. No earlier decision in the same proceedings is stated in the judgment.