V v General Medical Council [2025] CSOH 114: Original Jurisdiction and the Limits of Conditions in Interim Orders for Alleged Sexual Misconduct

1. Introduction

The decision of Lady Tait in Petition of V for review under section 41A(10) of the Medical Act 1983 ([2025] CSOH 114) is a significant Outer House judgment concerning the Court of Session’s role in interim fitness to practise orders and the threshold for substituting conditions for suspension where serious sexual misconduct is alleged.

The petitioner, anonymised as “V”, is a general practitioner registered with the General Medical Council (GMC). The respondent is the GMC. An Interim Orders Tribunal (IOT) of the Medical Practitioners Tribunal Service (MPTS) had imposed a 15‑month interim suspension order on 18 August 2025 under section 41A(1) of the Medical Act 1983. A request to the GMC’s Assistant Registrar for an early review of that order was refused.

V petitioned the Court of Session under section 41A(10) seeking:

termination of the interim suspension order; and
declarators that (a) the IOT’s decision to proceed in his absence and (b) its decision to impose suspension were unlawful.

The case sits at the intersection of several issues:

the scope of the Court of Session’s original jurisdiction under section 41A(10);
the necessity and proportionality of interim suspension vs interim conditions, especially in sexual misconduct cases;
the treatment of alleged procedural unfairness before the IOT and of errors in the presentation of a doctor’s fitness to practise history; and
the increasing proposal, post‑pandemic, to use remote-only practice and chaperone/monitoring conditions as less intrusive alternatives to suspension.

The judgment confirms and develops the approach taken in GMC v Hiew, B v GMC, GMC v K and Nursing and Midwifery Council, Petitioner, and is particularly notable for its clear statement that, in serious, patterned allegations of sexual misconduct and voyeurism, remote consultations and chaperone conditions may be inherently inadequate so that interim suspension becomes the “least intrusive” measure compatible with public protection and public confidence.

2. Summary of the Judgment

2.1 Outcome

Lady Tait refused the petition. She:

declined to terminate the 15‑month interim suspension order; and
declined to grant the declarators sought in respect of the lawfulness of the IOT’s decision and the Assistant Registrar’s refusal of an early review.

She reserved expenses.

2.2 Core holdings

Original jurisdiction under section 41A(10): The Court of Session exercises an original, not appellate or supervisory, jurisdiction. Its task is not to decide whether the IOT’s decision was lawful or reasonable, but to decide for itself whether the statutory test in section 41A(1)—including the requirement of necessity and proportionality—is met on the material before it.
Protection of the public and public interest engaged: On the evidence before the court (including further material obtained after the IOT hearing), the statutory grounds for an interim order—protection of members of the public and the public interest—were clearly engaged.
Suspension necessary and proportionate: Interim suspension, rather than conditions (even stringent ones such as remote-only practice, chaperones and recording), was held to be necessary and proportionate in light of:
- the number of complainers;
- the seriousness and pattern of the alleged sexual misconduct and voyeurism; and
- the petitioner’s fitness to practise history of boundary and privacy breaches.
Historic nature of allegations: The historic nature of the allegations (2007–2013) and delay in formal complaints did not materially weaken the case for interim suspension where the allegations disclosed a sustained pattern of conduct and where the investigation was now active.
Limited role of alleged IOT unfairness: Even assuming procedural concerns about the IOT hearing (short notice; refusal to adjourn; proceeding in absence; misstatements of the petitioner’s history), these went only to the weight to be given to the IOT’s determination. They did not control the court’s independent decision under section 41A(10). The court therefore saw no need to grant declarator about the lawfulness of those earlier decisions.
Length of order: A 15‑month period of interim suspension was held to be a proportionate precautionary measure in light of the seriousness and breadth of the allegations and the anticipated duration of the GMC investigation.

3. Factual and Procedural Background

3.1 The allegations

The allegations before the court concerned 11 complainers (10 having cooperated to the point of providing or agreeing to provide statements), in relation to a period between 2007 and 2013. They arose in the context of the petitioner’s work as an occupational health doctor and involved, in summary:

allegations of sexual abuse and sexual assault during clinical examinations;
intimate genital examinations, including:
- testicular examinations, allegedly including comparisons with a string of plastic balls;
- unasked-for prostate examinations on relatively young men; and
- penile examinations, including retraction of the foreskin without gloves.
patients allegedly being asked to strip completely naked and perform star jumps or mobility exercises while the petitioner observed from behind;
allegations involving vulnerable male staff (e.g. apprentices) as patients;
the absence of documentation in medical records either of the examinations or of any clinical indication requiring them.

The statements lodged described feelings of confusion, unease, violation and exploitation, as well as the harm to trust in doctors.

The petitioner denied all allegations.

3.2 Fitness to practise history

The petitioner’s prior regulatory history was central to both parties’ submissions and to the court’s reasoning. Lady Tait summarised it carefully:

2006 finding (GU clinic photographs): As a genito-urinary consultant, the petitioner took photographs of patients’ genitalia without recording this in the notes or recording consent, and sometimes without clearly explaining the purpose. The conduct was found “inappropriate” and a failure to respect dignity and privacy, but not so serious as to amount to serious professional misconduct.
2015 finding (occupational health photographs): The petitioner admitted taking photographs of (including vulnerable) patients between 2012 and 2013 on a personal device, transferring them to his home computer, failing to obtain adequate consent, failing to record the fact of photography, and sharing some images with colleagues without clinical, academic or teaching justification and without consent. The panel found this was misconduct impairing fitness to practise, undermining public confidence, and imposed conditions for 36 months.
2019–2023 interim conditions and 2024 warning: The petitioner was under interim conditions (including a requirement for a chaperone at face-to-face consultations) between March 2019 and December 2023. In October 2024, it was determined that he had arranged for a chaperone to observe assessments from an adjoining room without informing the patients or obtaining consent for that observation. This was held to be a breach of Good Medical Practice, and a warning (not a finding of impairment) was issued until October 2025.

It was common ground before Lady Tait—and she accepted—that the petitioner had not breached an order for interim conditional registration. Some earlier submissions to the IOT had wrongly asserted that he had previously breached such conditions.

3.3 The IOT hearing and early review request

The IOT hearing was fixed for 18 August 2025. The key points:

The GMC contacted the petitioner via his registered email with “pathfinder” emails and then formal notification of concerns, the IOT referral and hearing date, enclosing the bundle.
The petitioner was on holiday and said he only saw the notice the day before the hearing (17 August 2025).
He instructed his defence union (MDDUS), who instructed solicitor James Rowley.
Rowley, lacking time and instructions to prepare, applied for a postponement/adjournment. The IOT refused.
Without instructions sufficient to represent V substantively, Rowley withdrew from representation, but remained as an observer.
The IOT proceeded in the petitioner’s and his representative’s absence and imposed a 15‑month interim suspension order.

On 29 August 2025, Rowley applied for an early review of the interim order, putting forward:

fresh information from one of V’s employers that they would employ him only to conduct virtual (remote) consultations; and
the fact that V had been unable to attend or be represented at the original IOT hearing.

The Assistant Registrar refused that application on 3 September 2025. The reasons included the view that remote consultations would not adequately address the concerns, which involved sexualised and voyeuristic conduct.

4. Precedents and Authorities Cited

4.1 Jurisdiction and principles for section 41A applications

(a) GMC v Hiew [2007] 1 WLR 2007

Hiew is the foundational authority on how courts should approach applications under section 41A(10). The English Court of Appeal held that:

the court’s jurisdiction is original, not appellate or supervisory;
the court must decide for itself whether the criteria for an interim order are met, having regard to:
- the seriousness of the allegations;
- the nature and strength of the evidence available at the interim stage;
- the risk to patients and the public;
- the practitioner’s interests; and
- the stage and expected timescale of the investigation.
while the tribunal’s decision is entitled to “due respect” given its expertise, it is not decisive.

Lady Tait explicitly endorsed this approach, citing Hiew and noting it had already been followed in Scotland in GMC v K 2023 SC 1. Her application of Hiew is faithful and firm: she repeatedly stresses that she is not “reviewing” the IOT’s legality, but deciding for herself whether an interim order is presently justified.

(b) B v GMC 2022 SLT 961 and GMC v K 2023 SC 1

These Inner House decisions summarise and adopt the Hiew principles for the Scottish context:

B v GMC distilled the Hiew factors and endorsed the original-jurisdiction model.
GMC v K reaffirmed that section 41A(10) applications are not appellate reviews but fresh determinations, and emphasised the need to consider:
- seriousness of the allegations;
- nature and strength of the evidence;
- seriousness of risk; and
- prejudice to the practitioner.

Lady Tait expressly relied on GMC v K at [11], [72] and [73], treating it as the definitive Scottish statement of the Hiew approach and as confirming that the court’s task is to apply the statutory test afresh rather than review the tribunal’s reasoning.

(c) Kumar v GMC [2013] EWHC 452 (Admin)

Cited at [9], Kumar establishes that there is no separate right of appeal against IOT decisions. Challenges must proceed via section 41A(10) applications (and, in principle, judicial review on public law grounds). This underpins the importance and scope of the section 41A(10) jurisdiction.

4.2 Proportionality and Convention rights

(a) Bank Mellat v HM Treasury (No. 2) [2014] AC 700

Bank Mellat provides the now-standard four-stage structured proportionality test:

Is the objective sufficiently important to justify limiting a fundamental right?
Is the measure rationally connected to that objective?
Could a less intrusive measure be used without unacceptably compromising the objective?
Does the measure strike a fair balance between the individual’s rights and the societal interest?

The petitioner relied heavily on Bank Mellat (see [13]–[14]) to argue that:

interim suspension engages Convention rights (particularly Article 8 and, indirectly, Article 1 of Protocol 1 and Article 6);
therefore, proportionality must be strictly assessed; and
a range of less intrusive measures (remote-only work, chaperones, recording, audits) existed and ought to have been preferred.

Lady Tait accepted the relevance of proportionality and explicitly framed her analysis in necessity terms, which in this context imports proportionality (following GMC v K and NMC, Petitioner). She ultimately concluded that, in light of the gravity and pattern of allegations and the petitioner’s history, suspension was indeed the “least intrusive” effective means and so passed the Bank Mellat test.

(b) Nursing and Midwifery Council, Petitioner 2025 SLT 777

That Outer House decision (also cited by the petitioner) stresses:

interim orders “will often” interfere with Convention rights; and
where they do, proportionality is integral: the tribunal (and court) must consider whether:
- a shorter order,
- an order with conditions rather than suspension, or
- conditions that are less extensive
would adequately protect the relevant interests.

Lady Tait’s judgment can be read as applying that same structure: she explicitly considers whether conditions (including remote working and chaperoning) would be an adequate and less intrusive alternative, and explains why, in this specific context of alleged sexualised and voyeuristic behaviour, they are not.

4.3 Public protection vs public interest

(a) R (Sheikh) v GDC [2007] EWHC 2972 (Admin); NMC v Persand [2023] EWHC 3356 (Admin)

These cases, cited by the petitioner, emphasise that:

interim orders justified purely on the “public interest” limb (i.e. reputation/public confidence, as opposed to direct protective risk) should be exceptional; and
perfunctory statements of “public interest” are inadequate.

The petitioner argued that the IOT’s reasoning on the public interest was too cursory and did not meet this standard, and that this defect should count heavily in favour of termination.

While Lady Tait did not dwell on these authorities in her own reasoning, her analysis at [70] effectively finds that both the protection of the public and the public interest were engaged, and that the public interest element was far from “perfunctory”. She emphasises that a reasonably informed member of the public would be “offended or surprised” to learn that V could continue practising in the face of such allegations and history. In that way she aligns with Patel and Gupta (below) rather than with the narrower, exceptionalist reading of the public-interest limb.

(b) Patel v GMC [2013] 1 WLR 2694; Gupta v GMC [2002] 1 WLR 1691

These cases support the proposition that:

public confidence in the profession can itself justify an interim order where a well-informed member of the public would be shocked or offended to learn that the doctor could continue to practise (Patel); and
the personal or financial prejudice to the practitioner does not make a suspension order wrong if, otherwise, the public interest requires it (Gupta).

Lady Tait clearly adopts this public-confidence perspective at [70]. In doing so, she underscores that the public interest is not a marginal add-on but a substantive limb which, in sexual misconduct cases, will often be powerfully engaged.

4.4 Proceeding in absence and fairness

(a) Section 41A(4) Medical Act 1983 and Rule 31 of the 2004 Rules

Section 41A(4) provides that no order under section 41A(1) is to be made unless the practitioner has been afforded an opportunity to appear and be heard. Rule 31 of the General Medical Council (Fitness to Practise) Rules 2004, however, permits IOTs to proceed in the absence of the practitioner where appropriate.

The petitioner argued that proceeding in his absence, with very short notice, violated the spirit (if not the letter) of section 41A(4) and the common law right to a fair hearing.

(b) Yusuf v Royal Pharmaceutical Society of Great Britain [2009] EWHC 867 (Admin)

In Yusuf, the English Administrative Court stressed that a regulatory tribunal should proceed in a practitioner’s absence only when satisfied that the absence is voluntary, and even then with “utmost caution” and with active testing of the case.

Although this guidance was invoked by the petitioner, Lady Tait did not rule on whether the IOT had complied with it. Instead, she treated any such criticism as going to the weight the court should give to the IOT’s conclusions, rather than as determinative of the section 41A(10) question.

(c) Osborn v Parole Board [2014] AC 1115; AF (No 3) [2010] 2 AC 269

The petitioner relied on Osborn (importance of oral hearings and fairness) and AF (No 3) (the resentment and unfairness where a person cannot meaningfully influence proceedings) to criticise both the IOT’s refusal to adjourn and the Assistant Registrar’s refusal to permit early review.

Again, while the judge acknowledged these concerns in the context of submissions, her own decision remains grounded on the fresh assessment of risk and proportionality under section 41A(10) rather than on a free‑standing human rights/ procedural fairness analysis of the earlier GMC decisions.

4.5 Sexual misconduct and risk: Srinivas and related guidance

(a) GMC v Srinivas [2012] EWHC 2513 (Admin)

Srinivas involved allegations of inappropriate intimate examinations. The court there emphasised that such allegations can be sufficiently serious, even at an interim stage, to warrant suspension rather than conditions, due to the gravity and nature of the risk.

In the present case, the respondent drew on Srinivas to argue that:

allegations of intimate examinations without clear indication are inherently serious;
they directly implicate patient safety and trust; and
in such cases, interim suspension is often the appropriate precautionary response.

Lady Tait’s reasoning is consistent with this line: she highlights the seriousness of alleged intimate examinations and voyeurism in a clinical context, and treats them as strongly suggestive that conditions would not be sufficient.

(b) MPTS Guidance on imposing interim orders

The respondent drew attention to MPTS guidance (paragraph 60(b)), which indicates that where there is a pattern of sexually inappropriate conduct towards patients, conditions are likely to be inadequate. This guidance fits with the court’s conclusion that an alleged pattern of exploitation and abuse over years made suspension the only effective measure.

5. The Court’s Legal Reasoning

5.1 The statutory test under section 41A

Section 41A(1) authorises an IOT (or, via section 41A(10), the court) to impose an interim suspension or conditional registration order where:

it is necessary for the protection of members of the public; or
it is otherwise in the public interest; or
it is in the interests of the practitioner.

Under section 41A(10), where such an order is in force, the “relevant court” (here, the Court of Session) may:

terminate an interim suspension;
revoke or vary conditions on an order for interim conditional registration; or
substitute a different period (still within the statutory maximum).

As confirmed by Hiew and GMC v K, the court’s jurisdiction under section 41A(10) is original. The question is therefore not “was the IOT’s decision lawful?”, but “is an interim order now necessary and proportionate in light of the material before the court?”.

Lady Tait explicitly adopts this framing at [62]–[63], [67] and [73].

5.2 Assessment of the allegations and evidence

The judge carefully evaluated:

the number of complainers (11, 10 actively cooperating);
the nature of the alleged conduct (sexual assault, intimate touching, penetrative examinations, voyeurism by compelling naked exercise);
the consistency and pattern across complaints over a six‑year period; and
the absence of corresponding clinical records or indications in the notes.

At [68]–[69], she emphasises:

the alleged storage of these events in a clinical context over a prolonged period;
the similarities in how patients describe the examinations and instructions to undress; and
the lack of recorded justification in the medical records.

She notes that she is not determining contested facts (see [41], [48])—that is for any eventual substantive fitness to practise hearing. However, she treats the allegations, and the available supporting statements, as sufficiently cogent at this interim stage to justify the inferences that:

there is a real and appreciable risk of similar behaviour recurring if unrestricted practice continues; and
public confidence in the profession would be seriously undermined if the petitioner were permitted to practise unrestricted pending full investigation.

5.3 Relevance of the petitioner’s fitness to practise history

The petitioner sought to downplay his regulatory history, arguing:

no past finding of sexual misconduct or inappropriate clinical touching had ever been made;
the photographic incidents were contextually distinct and non-sexual; and
the 2023 decision resulted in no finding of misconduct or impairment, only a warning.

He further complained that GMC counsel had mischaracterised his history before the IOT by alleging he had previously breached interim conditions and had a “vast history of inappropriate conduct”, neither of which was strictly correct.

Lady Tait accepts that:

there had been no breach of interim conditions; and
those misstatements occurred at the IOT hearing.

But she rejects the notion that there had never been a finding of inappropriate conduct:

in 2006 the panel expressly found the photographic conduct “inappropriate” and failing to respect dignity and privacy;
in 2015, there were serious findings of misconduct based on boundary‑crossing photography and sharing images without consent.

At [69], she concludes that the petitioner’s fitness to practise history is clearly relevant to the present risk assessment. Taken together with the allegations, it suggests:

a concerning pattern of disregard for patient privacy and dignity; and
a tendency to exploit clinical encounters in ways inconsistent with professional boundaries.

Her reasoning illustrates an important point: even if past panels did not explicitly label conduct as “sexual misconduct”, findings of inappropriate handling of intimate images and failure to respect privacy can legitimately be weighed in assessing risk in current sexual misconduct allegations. The court is not confined to prior legal characterisations; it may look at the underlying facts and themes.

5.4 Protection of the public and public interest

Having appraised the allegations and history, Lady Tait decides that both statutory limbs are engaged:

Protection of the public: There is an appreciable risk, in a clinical setting, of:
- voyeuristic exploitation (compelling unnecessary nudity and observation); and
- inappropriate sexual touching (genital and prostate examinations without clear need).
This risk is rooted in:
- the alleged pattern over six years across multiple patients; and
- the petitioner’s past regulatory history on boundaries and privacy.
Public interest: Given the nature, extent and seriousness of the allegations, particularly when combined with the history, a reasonably informed member of the public would be “offended or surprised” to learn that the petitioner could continue to practise pending investigation ([70]). Thus, an interim order is required to maintain public confidence in the profession and in the regulatory process.

She explicitly rejects any suggestion that the reliance on public interest is perfunctory or generic ([70]). Rather, it is tightly linked to the specific facts and to the serious breach of trust alleged in a clinical context.

Importantly, she also notes that these considerations are not diminished by the historic nature of the allegations or the delay in formal complaints. What matters is the gravity and pattern, not whether the complaints were made promptly.

5.5 Conditions versus suspension: why conditions were inadequate

A central plank of the petitioner’s case was that, even if some form of interim order were justified, suspension was not “necessary” because suitably tailored conditions could mitigate any risk:

restricting the petitioner to remote (video/telephone) consultations;
requiring chaperones or observers for all consultations; and/or
requiring recording of consultations with random audits.

He argued that such conditions would:

substantially remove any risk of physical touching;
allow close monitoring of clinical practice; and
achieve regulatory aims with far less impact on his livelihood and reputation.

Lady Tait carefully addresses this at [71]–[72] and rejects it. Her reasons can be grouped as follows:

(a) Nature of the alleged misconduct: voyeurism and abuse of power

The allegations are not confined to inappropriate touching. They also include:

compelling unnecessary nudity;
ordering patients to carry out naked exercises for visual inspection;
exploiting clinical authority to secure compliance; and
doing so without recorded clinical justification.

Such behaviour is fundamentally about:

abusing the position of trust and authority;
misusing clinical encounters for sexual or voyeuristic purposes; and
subverting the proper doctor–patient relationship.

Remote consultations or chaperone conditions do not inherently prevent such abuse, especially where it is cloaked in apparently clinical explanations.

(b) Limitations of chaperones and remote-only practice

The court emphasises that:

a chaperone cannot generally “gainsay” (i.e. challenge or overrule) a doctor’s clinical judgment in real time; and
conditions depend heavily on the doctor’s own compliance, candour and adherence to the spirit, as well as the letter, of the restrictions.

Given:

the petitioner’s history of boundary and privacy issues; and
the nature of the allegations (where misconduct could be presented as clinically indicated),

Lady Tait is “not satisfied of the efficacy” of such conditions in preventing harm ([72]). That is a strong formulation: she effectively finds that, in cases of alleged patterned sexual misconduct and voyeurism, conditions may not be capable of affording adequate protection.

Additionally, the respondent had persuasively argued that:

voyeuristic conduct (unnecessary exposure, observation) can be carried out via video just as easily as in person;
restricting the petitioner to video consultations would not, of itself, stop him from instructing patients to expose themselves unnecessarily; and
recording or observing consultations might not capture all inappropriate conduct (e.g. subtle instructions, non-verbal cues) and raises its own privacy and data-protection concerns.

Lady Tait does not analyse those data-protection points in depth, but she clearly accepts the broader argument that remote practice and chaperones are not a panacea in this context.

(c) The “least intrusive means” analysis

After weighing:

the gravity and multiplicity of allegations;
the pattern and consistency over several years;
the supporting statements and absence of clinical documentation;
the petitioner’s boundary‑related fitness to practise history; and
the limited efficacy of proposed conditions,

Lady Tait concludes that suspension is the least intrusive effective measure ([72]). That conclusion directly engages the third limb of the Bank Mellat test. Since less intrusive measures would not, in her view, adequately protect patients or public confidence, the necessity requirement is satisfied even though suspension is highly intrusive for the petitioner.

5.6 Treatment of alleged procedural unfairness and the IOT’s role

The petitioner argued that:

he had very short notice of the IOT hearing (while on holiday);
a reasonable adjournment request was refused;
the IOT improperly proceeded in his and his representative’s absence; and
GMC counsel misrepresented his regulatory history (alleging a breach of conditions and a “vast history of inappropriate conduct”).

He said this rendered the IOT procedure “manifestly unfair”, and that its decision should accordingly be given no weight by the court. He also sought declarator that (a) the IOT’s decision to proceed and (b) its decision to impose suspension were unlawful.

Lady Tait deals with these points in a structured way:

Weight, not jurisdiction She accepts that concerns about fairness and factual misstatements are relevant to the weight to be given to the IOT’s determination. But since her own task is not to review the lawfulness of that determination, but to decide afresh under section 41A(10), she does not need to resolve every complaint about the IOT procedure.
Independent assessment At [73], she emphasises that her decision is not “narrow” or dependent on the IOT’s conclusions. She decides that, even disregarding the IOT’s reasoning, the statutory criteria for interim suspension are met on the material now before the court.
Refusal of declarator Because section 41A(10) is an original jurisdiction, and the question is whether an interim order is justified now, she declines to make declarators about the lawfulness of past GMC decisions. To do so would risk conflating the section 41A(10) jurisdiction with judicial review.

In effect, the judgment signals that while alleged unfairness at IOT level may influence how much persuasive weight the court affords to the IOT’s reasoning, it will rarely, of itself, be a route to termination where the court is independently satisfied that suspension is necessary and proportionate on the current evidence.

5.7 Early review refusal and competency

The petitioner also attacked the Assistant Registrar’s refusal to grant an early review, arguing that:

early review is the recognised means for a practitioner who did not participate in the original IOT decision to make representations;
new information—about remote-only employment and about correction of misstatements of his history—was plainly relevant and should have triggered a review; and
the refusal was irrational, and arguably beyond power.

The respondent, conversely, argued that:

the early review decision was not amenable to challenge under section 41A(10), and any such challenge was incompetent; and
in any event, the content of the early review application was not such as to justify a different outcome.

Lady Tait opted not to resolve these competency and rationality arguments directly. Instead, she:

focused on her primary task under section 41A(10): whether suspension remains necessary and proportionate; and
having decided that it does, she considered it unnecessary to address the legality of the Assistant Registrar’s decision.

As with the IOT fairness issues, this reflects a conscious narrowing of focus: section 41A(10) is not treated as a backdoor judicial review mechanism for all GMC procedural decisions. It is a standalone jurisdiction concerned with the existence and terms of the interim order.

5.8 Proportionality and duration of the order

Finally, Lady Tait had to consider whether the duration of 15 months was proportionate, even if suspension itself was justified.

She notes:

the seriousness and breadth of allegations across multiple complainers;
the ongoing nature and anticipated timescale of the GMC’s investigation (estimated at 3–12 months); and
the precautionary function of interim orders.

At [74], she concludes that a 15‑month order is proportionate “as a precautionary measure to protect the public from the apprehended risk and in the public interest.”

She thus rejects the petitioner’s suggestion of a shorter period (e.g. 3 months) as insufficient. Implicitly, she accepts that the gravest sexual misconduct allegations, involving multiple patients and a pattern over years, justify a relatively lengthy interim period while investigations and potential substantive proceedings are brought to conclusion.

6. Impact and Significance

6.1 Clarifying the nature of section 41A(10) jurisdiction in Scotland

While Hiew, B v GMC and GMC v K had already established that section 41A(10) jurisdiction is original, this judgment reinforces and operationalises that principle in a contested factual setting.

Key implications:

Applicants cannot succeed simply by showing that the IOT erred in law, misapplied guidance, or acted unfairly: the court asks whether, on the evidence now before it, an interim order is necessary and proportionate.
Conversely, regulators cannot rely on the fact that an IOT has imposed an order as creating any legal presumption in favour of continuation; the order must still be justified de novo.
Attempts to transform section 41A(10) applications into quasi-judicial review proceedings about IOT process or Registrar decisions are likely to be resisted. Public law challenges to procedural unfairness must, in general, be brought via ordinary judicial review, not via section 41A(10).

This provides clarity for practitioners and regulators about the proper scope and function of section 41A(10) petitions.

6.2 The threshold for conditions vs suspension in sexual misconduct cases

Perhaps the most practically important aspect of the judgment is its treatment of conditions as an alternative to suspension in cases of alleged sexual misconduct and voyeurism.

The decision suggests:

Where there are:
- multiple complainers;
- a sustained pattern of alleged sexualised conduct;
- voyeuristic elements (unnecessary nudity, exercises, visual inspection); and
- a history of boundary/privacy breaches,
conditions (even stringent ones) will often be inherently inadequate, because:
- misconduct may be cloaked in clinical justifications;
- chaperones lack authority or expertise to challenge clinical decisions in real time;
- voyeuristic harm can be inflicted via video as well as in person; and
- conditions depend heavily on the doctor’s own integrity and willingness to comply.
In such circumstances, suspension is not only justified but may be regarded as the least intrusive effective measure.

This has implications beyond the GMC:

for the MPTS and other health regulators (NMC, HCPC, GDC, etc.), when drafting and applying interim order guidance;
for defence representatives, who will need to provide highly concrete, verified proposals if they wish to argue that conditions can truly neutralise risk; and
for tribunals assessing “remote-only” practice as an alternative: it will not be enough simply to exclude physical contact; the possibility of exploitive visual conduct must also be addressed.

6.3 Treatment of historic allegations

The case also clarifies that the historic nature of allegations does not, by itself, negate the need for interim protective action. Where:

historic allegations reveal a pattern of serious misconduct;
new complainants have recently emerged; and
formal investigation is now underway,

the court may treat them as strongly engaging both public protection and public interest. Delay in complaining, especially in a sexual misconduct context, is not uncommon and does not necessarily diminish risk or seriousness.

6.4 Accuracy and use of fitness to practise history

The judgment underscores two linked points:

Regulators must present history accurately Misstating that a practitioner has previously breached conditions or has a “vast history of inappropriate conduct” can be highly prejudicial and is improper. Regulators should be scrupulous in ensuring that past findings are described precisely and in context.
Courts can look through the labels to the substance Even where earlier panels declined to categorise conduct as “serious professional misconduct” or as “sexual misconduct”, the underlying facts (e.g. taking intimate images without consent; sharing patient images without justification) can legitimately be treated as relevant to current risk in sexual misconduct cases.

This calls for careful, nuanced use of fitness to practise history in both regulatory and court proceedings.

6.5 Relationship with Convention rights and proportionality

The judgment is also an example of how Scottish courts now routinely incorporate Convention-compatible proportionality analysis (as per Bank Mellat and NMC, Petitioner) into interim order decisions.

Key aspects:

there is explicit recognition that interim suspension interferes with rights and must be justified;
the court weighs the impact on the doctor’s ability to earn a living against the seriousness and likelihood of harm to patients and to public confidence; and
the existence of theoretical “less intrusive” options is not enough; they must be practically effective in mitigating the specific risk.

The decision therefore exemplifies a mature, case-sensitive application of proportionality: rights-sensitive, but not rights-absolute, in a high-risk professional context.

7. Complex Concepts Simplified

7.1 Interim suspension order

An interim suspension order is a temporary measure that stops a doctor from practising while an investigation or case is ongoing. It is not a final sanction or finding of guilt; it is a precaution designed to:

protect patients and the public from possible harm; and/or
maintain public confidence in the profession and the regulator.

It can last up to 18 months at a time (with the possibility of further extensions by the court). The idea is that the interim order “buys time” for a full investigation and hearing.

7.2 Conditional registration vs suspension

Instead of suspending a doctor completely, a tribunal or court can (where the statute allows) let them continue to practise but only under specified conditions, such as:

working only under a supervisor;
not performing certain procedures;
only conducting remote consultations; or
always having a chaperone present.

Conditions are less drastic than suspension because they let the doctor continue some form of practice. But they are only appropriate if they genuinely protect the public and public interest as effectively as suspension would.

7.3 “Original jurisdiction” vs appeal/judicial review

When a court has original jurisdiction, it is acting as a decision-maker of first instance: it looks at the evidence and arguments and makes its own decision. It does not just check whether someone else’s decision was reasonable or lawful.

By contrast:

an appeal court usually asks whether the earlier decision-maker made an error of law or exercised their judgment unreasonably; and
judicial review looks at the lawfulness of the decision-making process, not at whether the outcome was “right”.

Section 41A(10) gives the Court of Session original jurisdiction. It decides for itself whether an interim order should continue, rather than reviewing the IOT’s process or reasoning.

7.4 Proportionality and “least intrusive means”

Proportionality is about fairness and balance. In this context it asks:

Is the aim (protecting patients / maintaining public confidence) important enough to justify limiting the doctor’s rights?
Does suspension help achieve that aim?
Could something less drastic than suspension (like conditions) do the job just as well?
Overall, does the benefit to the public outweigh the harm to the doctor?

If a less restrictive step (e.g. conditional practice) would protect the public just as well as suspension, then suspension is not proportionate. The least intrusive effective step must be chosen. In this case the court decided that, given the seriousness and pattern of alleged misconduct, suspension really was the least intrusive measure that would still effectively protect the public.

7.5 Protection of the public vs public interest

Section 41A(1) allows interim orders where:

they are necessary to protect members of the public (for example, where there is a real risk that patients could be harmed); or
they are otherwise in the public interest (for example, to maintain trust in the medical profession and confidence in regulators).

The two are related but distinct:

Protection of the public is about preventing actual or likely harm to patients.
Public interest includes preserving public confidence that serious allegations will be taken seriously and managed robustly.

In many serious misconduct cases, both limbs are engaged, as here.

8. Conclusion

V v GMC [2025] CSOH 114 is a significant addition to the Scottish and UK jurisprudence on interim fitness to practise orders. It reinforces the original nature of the court’s jurisdiction under section 41A(10) and demonstrates how that jurisdiction is to be exercised in a factually complex, high-stakes case involving multiple historic allegations of sexual misconduct and voyeurism.

The judgment’s main contributions can be summarised as follows:

It confirms that challenges based on alleged unfairness or error at IOT level will not generally succeed unless the court, on its own assessment, is not satisfied that the interim order remains necessary and proportionate.
It clarifies that in serious, patterned allegations of sexual misconduct, especially where there is a supporting history of boundary and privacy breaches, interim suspension is likely to be the only effective measure; conditions, including remote-only practice and chaperoning, will often be inadequate.
It emphasises that historic allegations can still powerfully engage both the protection of the public and the public interest where they suggest a sustained pattern of abuse of trust in a clinical setting.
It illustrates a careful, rights-aware proportionality analysis that nonetheless concludes that the protection of patients and maintenance of public confidence can legitimately require substantial interference with a doctor’s ability to practise and earn a livelihood at the interim stage.

For regulators, the message is that robust interim suspension can be warranted where there is cogent evidence of a serious pattern of sexualised misconduct and boundary violations. For practitioners and their advisers, the judgment underlines that to displace an interim suspension in such cases, they must present not only credible challenges to the allegations, but also genuinely effective, concrete alternatives that will protect both patients and public confidence.