Dr Premila Thampi v The General Medical Council

In a statutory appeal from a medical practitioners tribunal, the appellate court must make its own assessment of whether the sanction is appropriate and proportionate in the public interest. A tribunal may consider the impact of misconduct on a patient, but it must not make or rely on an uncharged finding of causative psychological harm without a fair opportunity to address it. Such an error does not necessarily invalidate a finding of impairment if that finding rests independently on serious proven misconduct. Guidance stating that exceptional circumstances may justify taking no action does not impose an exceptionality threshold. Proportionality requires the tribunal to assess the established consequences of the sanction, including certain loss of employment. On the particular facts, impairment was sufficient and no further action was proportionate.

Dr Premila Thampi appealed under section 40 of the Medical Act 1983 against findings by a Medical Practitioners Tribunal that her fitness to practise was impaired and that her registration should be suspended for three weeks. The proceedings arose from her management of an instrumental delivery in 2016, involving failures concerning informed consent and communication with the patient.

The tribunal found impairment on public-confidence and professional-standards grounds, but not on patient-safety grounds. It imposed suspension notwithstanding substantial mitigation, including insight, remediation, an isolated incident and the absence of repetition. The appeal challenged the tribunal’s treatment of alleged psychological harm, its assessment of relevant factors and the public interest, its approach to taking no action, and its proportionality assessment, particularly the effect of suspension on employment.

1. Impairment. The tribunal was entitled to consider the impact of the proven failings on the patient. It nevertheless erred in finding that the failings caused psychological harm. No such harm had been alleged, there was no expert evidence or adequate reasoning, and the appellant had not been given a fair opportunity to address causation. The error did not vitiate the impairment finding because the tribunal’s reasoning was independently based on the serious failures to obtain informed consent and communicate appropriately, assessed against public confidence and professional standards.
2. The tribunal was entitled to regard the patient as being in a vulnerable position because she was in stirrups and receiving an epidural. It properly considered the isolated nature of the incident, the absence of clinical negligence, insight, remediation, apology, positive testimonials and low risk of repetition. Those factors did not outweigh the seriousness of the proven failures. Grounds 1 and 2 failed.
3. Public interest and no action. The tribunal’s sanction-stage direction that it should not rely on psychological harm was substantively correct and was followed. The tribunal’s public-interest assessment was not materially contaminated by its earlier error. Ground 3 failed.
4. Paragraph 68 of the Sanctions Guidance does not impose a threshold of exceptional circumstances before a tribunal may take no action. It indicates that no action is unusual after impairment, while leaving the tribunal to reach its own view on the facts. The tribunal treated exceptionality as a threshold and therefore erred. Ground 4 succeeded.
5. Proportionality. The evidence established that suspension would immediately terminate the appellant’s employment. By hoping that a short suspension might avoid that consequence, the tribunal weighed proportionality against a hypothetical situation and failed properly to balance the appellant’s interests against the public interest. The three-week suspension was disproportionate. Ground 5 succeeded.
6. The appeal against impairment was dismissed. The appeal against sanction was allowed, the suspension was overturned, and no further action beyond the finding of impairment was substituted.

• Medical Practitioners Tribunal: found fitness to practise impaired on 8 May 2025 and imposed a three-week suspension on 12 June 2025.
• High Court (Administrative Court): dismissed the appeal against impairment, but allowed the appeal against sanction, overturned the suspension and substituted no further action beyond impairment.