Sheill v The General Medical Council

Factual and Procedural Background

The Appellant had been a general practitioner for approximately 23 years without prior disciplinary issues before the General Medical Council (GMC) Fitness to Practise Panel directed on 14 August 2007 that his name be erased from the Medical Register. He was Medical Director of four private clinics, two in Tunbridge Wells, one in Ashford, and one in Crawley, all owned by a family company in which he had an interest. His practice included occupational health and cosmetic dermatology, notably Botox and dermal fillers, but also treatments such as weight loss drugs.

Following inspections and investigations by the Healthcare Commission concerning unregistered "registrable activities" at his clinics and his conduct, the GMC initiated proceedings. After interim hearings and a 16-day substantive hearing, the Fitness to Practise Panel found his fitness to practise impaired by misconduct and imposed an immediate suspension, later directing erasure.

The Appellant appealed under section 40(7) of the Medical Act 1983, challenging specific findings of the Panel and contending that suspension for one year would have been a more appropriate sanction than erasure.

Legal Issues Presented

1. Whether the findings of the Fitness to Practise Panel regarding the Appellant’s misconduct, particularly dishonesty and misleading a patient, were properly made.
2. Whether the sanction of erasure was proportionate and appropriate given the facts and findings.
3. The proper approach and scope of the appellate court’s review of the Fitness to Practise Panel’s findings and sanction under section 40 of the Medical Act 1983.

Arguments of the Parties

Appellant's Arguments

• The Appellant accepted impairment of fitness to practise but disputed the finding of dishonesty related to a false claim that a patient requested non-notification of her GP, arguing that the allegation was not properly particularised or fairly put.
• He contended that erasure was a disproportionate sanction and that suspension for one year would be appropriate, especially if the dishonesty finding was set aside.
• Regarding the allegation of misleading a patient about his registration status, the Appellant asserted it was an error of judgment rather than misconduct equivalent to dishonesty.

Appellee's Arguments (General Medical Council)

• The GMC maintained that the findings of misconduct, including dishonesty and misleading a patient, were properly made on the evidence, with the Panel entitled to prefer the patients’ accounts over the Appellant’s.
• The GMC argued that erasure was the appropriate sanction given the seriousness of the misconduct, persistent lack of insight, disregard for regulatory bodies, and unprofessional behaviour.
• They submitted that the absence of the dishonesty finding would not affect the appropriateness of erasure.

Table of Precedents Cited

Court's Reasoning and Analysis

The court began by outlining the statutory framework governing the Fitness to Practise Panel’s powers under the Medical Act 1983 and the procedural rules, emphasizing the separate stages of fact-finding, impairment, and sanction. It reiterated the appellate approach, which involves a review of the Panel’s findings with deference to its professional expertise, especially on issues of witness credibility, unless there is a material error of law or fact.

The court considered the Healthcare Commission’s role and the Appellant’s repeated non-compliance with regulatory requirements, including unregistered registrable activities and failure to cooperate with inspections.

Regarding the allegations involving two patients, the court analyzed the evidence and findings:

• Miss KL: The Panel found that the Appellant failed to notify her GP of treatment and falsely claimed this was at her request, constituting dishonesty. The court noted deficiencies in how the dishonesty charge was particularised and presented, including the absence of clear identification of when the false claim was made and the relevant documents not being before the Panel or referred to in submissions. The court found that this lack of clarity and fair ventilation of the allegation was unsatisfactory and set aside the findings of dishonesty and false claim related to Miss KL, although it accepted the Panel’s preference for her evidence over the Appellant’s on credibility grounds.
• Mrs ES: The Appellant did not dispute the suspension of his registration but denied misleading her. The court accepted the Panel’s finding that, although not strictly dishonest, the failure to disclose his suspension in circumstances where the patient expressly asked about his qualifications was misleading. The court viewed this as an error of judgment rather than deliberate untruthfulness but upheld the finding.

Turning to sanction, the court noted that despite setting aside the dishonesty findings related to Miss KL, the Panel’s extensive findings of misconduct, including disregard for regulatory bodies, inappropriate prescribing, failure to obtain informed consent, unprofessional behaviour, and lack of insight, justified erasure. The court agreed that conditions or suspension would be insufficient to protect the public interest or uphold professional standards, giving due respect to the Panel’s expert judgment.

Holding and Implications

The court ALLOWED IN PART AND DISMISSED IN PART the appeal. It set aside the findings of dishonesty and false claim related to the Appellant’s conduct towards Miss KL but dismissed the appeal in all other respects, including the finding of misleading conduct towards Mrs ES and the sanction of erasure.

The direct effect is that the Appellant’s name remains erased from the Medical Register. No broader new precedent was established, and the decision reinforces the deference appellate courts must give to professional disciplinary panels on matters of fact, credibility, and sanction, while underscoring the necessity for clear and fair articulation of serious allegations such as dishonesty.