Professional Standards Authority for Health and Social Care v General Medical Council & Anor

On an appeal under National Health Service Reform and Health Care Professions Act 2002, the court reviews, rather than rehears, a tribunal’s evaluative sanction decision. Interference is justified only where the tribunal made an error of principle or reached a conclusion outside the range reasonably open to it.

Guidance stating that erasure is likely to be appropriate where a doctor abuses a professional position and involves a vulnerable patient does not make erasure inevitable. The tribunal must assess the case in the round, including vulnerability, predatory behaviour, remediation, insight, passage of time, public confidence and proportionality. A finding that serious misconduct did not involve exploitation of vulnerability may properly remain open on the evidence.

The Professional Standards Authority appealed under section 29 of the National Health Service Reform and Health Care Professions Act 2002 against a Medical Practitioners Tribunal’s decision to suspend Dr Cían Hughes for 12 months rather than erase him from the medical register.

The Tribunal had found serious misconduct involving improper communications and a sexual relationship with a vulnerable former patient, and had found his fitness to practise impaired. It had rejected three additional allegations, including predatory conduct and awareness of the patient’s personal feelings before December 2013. The Authority challenged the sanction and the finding that Dr Hughes had not exploited the patient’s vulnerability.

1. Appeal dismissed. The court exercised a review jurisdiction under section 29 of the National Health Service Reform and Health Care Professions Act 2002. The question was whether the Tribunal’s decision was wrong, applying CPR r 52.21(3), rather than whether the court would have imposed the same sanction.
2. Sanction was an evaluative, multifactorial decision involving fact and law. The court was required to give the specialist Tribunal an appropriate measure of respect. It could interfere only for an error of principle or where the evaluation fell outside the bounds of what the Tribunal could properly and reasonably decide, following Bawa-Garba v General Medical Council [2018] EWCA Civ 1879, as endorsed in Sastry v General Medical Council [2021] EWCA Civ 623 and General Medical Council v Gilbert [2026] EWCA Civ 53.
3. The Tribunal had adequately considered the Sanctions Guidance. Paragraph 148 stated that erasure was likely to be appropriate where a vulnerable patient was involved, but it did not require erasure in every such case. The heading concerning predatory behaviour, the Tribunal’s rejection of predatory allegations, the mitigating evidence and its conclusion that the misconduct was not fundamentally incompatible with continued registration supported its decision to impose suspension.
4. The Tribunal was entitled to take account of Dr Hughes’s admissions, apology, remediation, insight, professional record, lack of other complaints and the passage of time. It was also entitled to consider the continuing impact of suspension despite his not practising in the United Kingdom.
5. On Ground Two, the evidence did not require a finding that Dr Hughes had exploited Patient A’s vulnerability in the ordinary sense of that term. The Tribunal had considered the full messages and direct evidence and was entitled to distinguish the early communications from an escalating pattern of exploitation. Its conclusion was within the reasonable range open to it.
6. The 12-month suspension was the maximum single period permitted by section 35D(2) of the Medical Act 1983. The Authority’s appeal was dismissed.

• High Court (Administrative Court): The Authority’s statutory appeal against the Tribunal’s sanction decision was dismissed.
• Medical Practitioners Tribunal: The Tribunal found impairment of fitness to practise and imposed a 12-month suspension rather than erasure.