Amir Ahmed Bhatti v County Durham and Darlington NHS Foundation Trust

On an application for mandatory interim relief requiring an employer to restore a clinician to practice, the court must have a high degree of assurance that the claimant will establish the claimed right at trial. In assessing whether there is a serious issue to be tried, the court makes a provisional assessment of the merits, while recognising the employer’s expertise and discretion in matters of patient safety. A restriction on duties need only be rational and made in good faith; the stricter MHPS requirements for formal exclusion apply where the practical effect of the measure is to prevent all existing work and no alternative work is provided. The court examines the latest decision in its factual context, but earlier decisions may remain relevant. Procedural defects do not justify relief unless they could have affected the substantive outcome.

The claimant, a consultant general and breast surgeon employed by the defendant NHS foundation trust, sought a mandatory and prohibitory interim injunction requiring the removal of restrictions imposed on his clinical practice. Restrictions began with a decision in February 2025 to prevent him undertaking breast cancer surgery pending retraining. In October 2025 the Trust prohibited all clinical practice, while stating that non-clinical duties remained available. In January 2026 the Trust reviewed and maintained the restrictions amid an ongoing MHPS investigation and additional patient-safety and probity concerns.

The central issues were whether the January 2026 decision raised a serious issue to be tried, whether the earlier decisions and alleged MHPS procedural breaches were relevant, and whether damages and the balance of convenience supported interim relief.

1. Application refused. The claimant had not shown a serious issue to be tried in relation to the January 2026 decision. The mandatory relief sought required a high degree of assurance that he would establish his right at trial: Nottingham Building Society v Eurodynamic Systems plc [1993] FSR 468.
2. The court applied the three-stage approach derived from American Cyanamid v Ethicon Ltd (No 1) [1975] AC 396, including a provisional assessment of the merits where reinstatement is sought. The Trust’s discretion had to be exercised rationally, in good faith, and consistently with the implied term of trust and confidence. The February 2025 restriction was within the range of reasonable responses to systemic breast-service failings and patient-safety concerns. The proposed retraining was not shown to be irrational or irrelevant.
3. MHPS was not incorporated expressly at this interlocutory stage. Nevertheless, because the Trust repeatedly stated that the investigation was being conducted under MHPS, its provisions were relevant to whether the Trust acted consistently with the implied obligation of trust and confidence: Jain v Manchester University NHS Foundation Trust [2018] EWHC 3016 (QB). MHPS requirements governing formal exclusion did not automatically apply to lesser restrictions.
4. The October 2025 decision was expressed as a restriction, but its practical effect was provisionally tantamount to exclusion because it stopped all the claimant’s existing work and no alternative work was shown to have been provided. The Trust should therefore have considered the substantive MHPS safeguards, including whether a lesser measure was necessary. In particular, it had not sufficiently addressed why the claimant’s non-breast general surgery had to be restricted.
5. The January 2026 decision nevertheless stood on materially enlarged grounds. The amended investigation terms of reference raised serious patient-safety and probity concerns based on identified patient incidents, the Look Back exercise and external review. The decision-maker was entitled to adopt a precautionary approach and give real weight to professional judgment on patient safety: Jain v Manchester University NHS Foundation Trust [2018] EWHC 306. The possible defects in earlier decisions did not undermine the later decision, which addressed the circumstances as they stood in January 2026.
6. Failure to follow every MHPS procedural step, including a formal review, preliminary report or case conference, did not establish entitlement to relief because the claimant had not shown that compliance would have altered the outcome. The balance of convenience would in any event have favoured maintaining the restrictions because of the continuing patient-safety and probity concerns.
7. The claimant was ordered to pay the defendant’s costs, summarily assessed at £47,000.