QUEEN'S BENCH DIVISION
Strand, London, WC2A 2LL
B e f o r e :
| Professional Standards Authority for Health and Social Care
|- and -
|General Medical Council
Dr David Henry Dighton
Mr Ivan Hare QC (instructed by GMC Legal) for the First Respondent
The Second Respondent made written submissions only
Hearing date: 22 October 2020
Crown Copyright ©
Mrs Justice Farbey :
The High Court's jurisdiction
The correct approach to the MPT's findings
"(b) The court, as any appeal court, will correct material errors of fact and law but be very cautious about upsetting conclusions of primary fact particularly when dependent on an assessment of credibility of witnesses, whom the Tribunal has had the advantage of seeing and hearing (see Assicurazioni Generali SPA v. Arab Insurance Group (Practice Note:  EWCA Civ 1642); Southall v. GMC  EWCA Civ 407,  2 FLR 1550); although
(c) An appeal court may draw any inferences of fact which it considers justified on the evidence (CPR 52.11(4)).
(d) An appellate court approaches Tribunal determinations about what constitutes serious misconduct or what impairs a person's fitness to practise or what is necessary to maintain public confidence and proper standards in a profession with diffidence (Fatnani and Raschi v. GMC  1 WLR 1460; Khan v. General Pharmaceutical Council  UKSC 64,  1WLR 1693).
(e) This approach applies also to questions of sanction, which are similarly evaluative (ibidem, and see Bawa-Garba  EWCA Civ 1879); although
(f) Certain matters such as dishonesty or sexual misconduct may enable a court to assess what is needed to protect the public or maintain reputation more easily for itself and, therefore, attach less weight to the Tribunal's expertise (Council for the Regulation of Healthcare Professionals v. The GMC and Southall  EWHC 579 Admin;  Lloyd's Rep Med 365, para.11; Khan at para.36)".
GMC guidance on the duties of doctors
"…If you assess, diagnose or treat patients, you must:
a. adequately assess the patient's conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient
b. promptly provide or arrange suitable advice, investigations or treatment where necessary
c. refer a patient to another practitioner when this serves the patient's needs".
"prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient's health and are satisfied that the drugs or treatment serve the patient's need".
"8. If you are not the patient's general practitioner and you accept a patient for treatment without a referral from the patient's general practitioner, then you must:
(a) explain to the patient the importance and benefits of keeping their general practitioner informed
(b) inform the patient's general practitioner, unless the patient objects
(c) where possible, inform the patient's general practitioner before any treatment is started, unless the patient objects to this disclosure.
9. If the patient does not want their general practitioner to be informed, or has no general practitioner, then you must:
(a) take steps to ensure that the patient is not suffering from any medical condition or receiving any other treatment that would make the prescription of any medicines unsuitable or dangerous
(b) take responsibility for providing all necessary aftercare for the patient until another doctor agrees to take over".
Guidance on sanctions
"107. The tribunal may erase a doctor from the medical register in any case – except one that relates solely to the doctor's health and/or knowledge of English – where this is the only means of protecting the public.
108. Erasure may be appropriate even where the doctor does not present a risk to patient safety, but where this action is necessary to maintain public confidence in the profession. For example, if a doctor has shown a blatant disregard for the safeguards designed to protect members of the public and maintain high standards within the profession that is incompatible with continued registration as a doctor.
109. Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive).
a. A particularly serious departure from the principles set out in Good Medical Practice where the behaviour is fundamentally incompatible with being a doctor.
b. A deliberate or reckless disregard for the principles set out in Good Medical Practice and/or patient safety.
d. Abuse of position/trust ... the public's trust in the profession.
j. Persistent lack of insight into the seriousness of their actions or the consequences".
130. A particularly important consideration in these cases is whether a doctor has developed insight or has the potential to develop, insight into these failures. Where insight is not evident, it is likely that conditions on registration or suspension may not be appropriate or sufficient.
132. However, there are some cases where a doctor's failings are irremediable. This is because they are so serious or persistent that, despite steps subsequently taken, action is needed to maintain public confidence. This might include where a doctor knew, or ought to have known, they were causing harm to patients and should have taken earlier steps to prevent this."
The parties' submissions
Analysis and conclusions
Note: this judgment was corrected on 31 December 2020 by correcting the citation of Professional Standards Authority for Health and Social Care v Health and Care Professions Council & Roberts  EWHC 1906 (Admin).