General Medical Council v Dr Manish Tripathi

On an appeal against a professional disciplinary sanction, a tribunal must show that it considered the applicable version of the sanctions guidance and the material factors it identifies. A materially outdated test, or failure to explain the treatment of a relevant factor, may make the decision wrong and unjust because of a serious irregularity.

Assessing a significant risk of repetition requires attention both to the likelihood of recurrence and to the seriousness of the harm if it occurs. A real but quantitatively small risk may be significant where the possible misconduct is serious. An appellate court must still respect a specialist tribunal’s evaluative judgment and may not substitute erasure merely because another case imposed that sanction.

The General Medical Council appealed under section 40A of the Medical Act 1983 against a Medical Practitioners’ Tribunal decision suspending Dr Manish Tripathi for 10 months after findings of sexually motivated misconduct, sexual harassment and impaired fitness to practise. There was no challenge to the Tribunal’s findings on facts or impairment.

The appeal concerned whether the Tribunal had used an outdated version of the Sanctions Guidance, failed to address its serious-harm factor, misapplied its significant-risk-of-repetition criterion, or given inadequate weight to public confidence and professional standards. The GMC sought erasure; Dr Tripathi argued that suspension was proportionate.

1. Appeal allowed; sanction quashed. The appeal was a review under section 40A of the Medical Act 1983. The Tribunal’s sanction decision was wrong and unjust because of serious irregularities on grounds 1–3.
2. Outdated guidance. The Sanctions Guidance was not to be followed as if it were a statute. But its relevant wording had materially changed from conduct “fundamentally incompatible” with registration to conduct “difficult to remediate”. The Tribunal quoted the outdated provisions despite having been addressed on the current version. The court could not infer that it had applied the right test or properly considered the current questions. The error was material: General Medical Council v Stone [2017] EWHC 2534 (Admin) and General Medical Council v Bramhall [2021] EWHC 2109 (Admin) reinforced the need to address relevant guidance and give adequate reasons.
3. Serious harm. The Tribunal omitted paragraph 109(c), which identifies serious harm as a possible indicator for erasure. Serious harm is not confined to physical injury; serious psychological harm may qualify. The findings about the patient’s experience were capable of supporting such a conclusion. The Tribunal had to explain why the harm was not serious if that was its view.
4. Risk of repetition. Paragraph 97(g) required consideration of whether the risk was significant, not merely whether recurrence was likely. That assessment includes the seriousness and impact of the conduct if repeated. A real but small chance may be significant depending on the conduct. The Tribunal did not demonstrate that it assessed this dimension, as explained in General Medical Council v Khetyar [2018] EWHC 813 (Admin) and General Medical Council v Konathala [2025] EWHC 1550 (Admin).
5. No substitution of erasure. Under Bawa-Garba v General Medical Council [2018] EWCA Civ 1879 and General Medical Council v Gilbert [2026] EWCA Civ 53, an appellate court must respect a specialist tribunal’s evaluative judgment unless it contains an error of principle or falls outside the bounds of what it could properly and reasonably decide. Although Konathala resulted in erasure, each case depended on its facts. The Tribunal’s decision not to erase Dr Tripathi was within the range of decisions open to it, particularly given that it had heard from him.
6. The sanction was remitted to the Medical Practitioners’ Tribunal for a fresh determination by a differently constituted tribunal.

• High Court (Administrative Court): The GMC’s appeal against the Tribunal’s 10-month suspension was allowed. The sanction was quashed and remitted for a fresh sanction determination.
• Medical Practitioners’ Tribunal: The Tribunal had found the allegations proved and fitness to practise impaired, and imposed a 10-month suspension with review. No citation for that decision is stated in the judgment.