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British Medical Association, R (On the Application Of) v General Medical Council
Smart Summary
Factual and Procedural Background
By an order dated 17 April 2025 following a rolled-up hearing, Judge Lambert granted Company A permission to apply for judicial review against Company B's guidance "Good Medical Practice" (GMP) but dismissed the substantive claim and refused an extension of time to file the judicial review claim form. Company A appealed with leave granted by Judge Zacaroli on 29 July 2025.
The claim challenged Company B's use of the collective phrase "medical professionals" in GMP. Company A's original challenge had two elements: (i) the terminology question (use of "medical professionals" to describe both doctors and associates) and (ii) the production of unitary guidance applying to both doctors and associates. On appeal the unitary-guidance challenge was abandoned; the appeal concerns only the terminology issue and related process and delay points.
Relevant legislative and regulatory background in the opinion: the Medical Act 1983 (the 1983 Act) (including s.1, s.2, s.35 and s.49), the Health Act 1999 (s.60) and the Anaesthesia Associates and Physician Associates Order 2024 ("AAPA Order") made 13 March 2024 (Company B became regulator for physician associates and anaesthesia associates from 13 December 2024). GMP had a near-final draft approved 27 April 2023, an embargoed copy sent to some Company A members 15 August 2023, and was published 22 August 2023 (coming into effect 30 January 2024). Company A first objected formally on 20 May 2024, sent a pre‑action protocol letter on 21 June 2024 and lodged the claim on 3 July 2024.
Legal Issues Presented
- Whether Company B's use of the term "medical professionals" in GMP was an actionable misdirection in law because inconsistent with the statutory framework (Ground 1).
- Whether Company B's decision-making process in adopting the term "medical professionals" breached the Padfield principle or was Wednesbury irrational (Ground 2).
- Whether the judge erred in refusing an extension of time for filing the claim form (Ground 3).
Arguments of the Parties
Appellant's Arguments (Company A)
- The use of "medical professionals" was inconsistent with the statutory framework and amounted to a misdirection in law (Ground 1).
- If tested under R(A), GMP either (i) contained a wrong positive statement of law that could induce unlawful conduct or (ii) presented a misleading account of the law; alternatively, the terminology breached Padfield and/or was Wednesbury irrational (sub‑grounds 1A–1C).
- Company B's reasoning in adopting the term was flawed or inadequate and therefore unlawful on Padfield/Wednesbury grounds (Ground 2); Company A relied on fresh evidence said to show Company B felt bound to use the term and did not properly analyse whether it furthered statutory objectives.
- The judge should have extended time because the decision date was disputed, GMP was draft in August 2023, the AAPA Order and further consultation in 2024 changed circumstances, and Company A had good reasons for delay (Ground 3).
Respondent's Arguments (Company B)
- The term "medical professionals" is accurate, not a protected title, not defined in the 1983 Act and GMP does not encourage unlawful conduct; therefore no misdirection of law arises.
- R(A) provides the appropriate test for challenges to policy/guidance and, under that test, GMP does not fall within the categories of unlawfulness identified in R(A).
- Company B's consultation and decision‑making process was detailed and engaged stakeholders (including Company A); the use of the term was reasonable, aimed at clarity/readability and consistent with promoting statutory objectives (Padfield/Wednesbury defence).
- Company B relied on fresh evidence (including the Leng Review) and contended the appeal might be academic; Company B also relied on the merits and prejudice/administration considerations to oppose extension of time.
Table of Precedents Cited
| Precedent |
Rule or Principle Cited For |
Application by the Court |
| Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC112 |
Established that guidance is unlawful if it permits or encourages unlawful conduct; guidance drafters are not required to eliminate all risk of misreading. |
Used as part of the common-law foundation for assessing when guidance may be unlawful; court applied its narrow formulation (guidance must direct recipients to act contrary to legal duty to be unlawful). |
| R(A) v Secretary of State for the Home Department [2021] UKSC 37 |
Identified three categories where policy/guidance may be unlawful (positive wrong statement of law; failure to give accurate legal advice where duty exists; misleading full account of legal position). |
The court applied R(A) as the appropriate test to assess whether GMP's use of "medical professionals" amounted to unlawful guidance; concluded GMP did not fall into the R(A) categories relied upon by Company A. |
| R(BF) Eritrea v Home Secretary [2021] UK SC38; [2021] 1 WLR 3967 |
Reiterated that policy guidance must not direct recipients to do something contrary to legal duty and clarified limits on imposing duties to remove risk of misapplication. |
Referred to to support the narrow approach: policy guidance need not eliminate risk of misapplication; applied to reject Company A's broader contention that GMP must remove all risk of confusion. |
| R (Letts) v Lord Chancellor [2015] EWHC 402 (Admin); [2015] 1 WLR 4497 |
Illustrated that policies need not prescribe detailed decision‑making steps; policies may identify categories requiring further consideration. |
Used to support the proposition that GMP need not provide an exhaustive legal account; court treated GMP as a high-level ethical framework rather than a comprehensive legal statement. |
| Associated Provincial Picture Houses Limited v Wednesbury Corporation [1948] 1 KB 223 |
Classic test of irrationality (Wednesbury): decision must be so unreasonable that no reasonable authority could have come to it. |
Applied in assessing Company A's irrationality challenge; court found the decision to use the term was within the range of reasonable responses and not Wednesbury irrational. |
| Padfield & Ors v Ministry of Agriculture, Fisheries and Food [1968] A.C.997 |
Power must be exercised to promote the Act's policy; discretion cannot be used in a way that frustrates statutory purpose. |
Applied to test whether Company B's use of the term frustrated the purposes of the 1983 Act/AAPA Order; court held it did not and that use promoted statutory objectives of protecting the public and maintaining standards. |
| R(Law Society) v Lord Chancellor [2018] EWHC 2094 (Admin); [2019] 1 WLR 1659 |
Explained two aspects of irrationality: outcome and flawed process (reliance on irrelevant considerations or lack of evidential basis). |
Referred to when addressing Company A's challenge to Company B's reasoning process; court found no gap or critical flaw in Company B's reasoning. |
| R v Secretary of State for the Home Department ex parte Oladhinde [1990] 1 AC 254 |
Warning against deciding public‑law challenges by creating wholly new categories; law of judicial review should have a solid foundation. |
Used to caution against accepting a novel public‑law test outside established principles; supported court's application of established authorities (R(A), Padfield, Wednesbury). |
| R (Timson) v SSWP [2022] EWHC 2392 (Admin) |
Observed the helpfulness of the R(A) categories as a guide in considering whether written policy or guidance is unlawful. |
Used to support the court's application of R(A) categories as a helpful framework. |
| R (CPH) v SSHD [2025] EWHC 848 (Admin) |
Referenced as a decision that was not concerned with statements of law. |
Distinguished from the present case to justify applying R(A) principles here. |
| R v Department of Transport Ex Parte Presvac Engineering [1992] 4 Admin LR 121 |
Authority on when time starts to run for judicial review (date of decision). |
Applied in discussion of Ground 3 to identify the decision date and assess delay. |
| Maharaj v National Energy Corporation of Trinidad and Tobago [2019] UKPC 5; [2019] 1 WLR 983 |
Test for extension of time: "good reasons for extending time" and factors including importance, prospects, prejudice and public interest. |
Applied to assess whether the judge erred in refusing extension of time; court concluded Company A had not shown good reasons and that merits were weak. |
| Manning v Sharma [2009] UKPC 37 |
Authority cited on factors relevant to extension of time (prejudice/detriment). |
Referred in the court's assessment of extension of time factors. |
Court's Reasoning and Analysis
The court framed the appropriate legal test by reference to R(A): policy or guidance may be unlawful only if it (i) contains a positive statement of law that is wrong and induces breach of legal duty, (ii) is promulgated where there is a duty to provide accurate legal advice but fails to do so, or (iii) purports to give a full legal account but presents a misleading picture. The court rejected Company A's invitation to adopt a broader or different test in the absence of any concrete alternative.
Applying that framework, the court found:
- The phrase "medical professionals" is not a protected or statutory title and is not defined in the 1983 Act; its use in GMP is therefore not a statement of law that could, of itself, induce unlawful conduct under s.49 of the 1983 Act.
- GMP expressly explains the term on its front page and elsewhere, identifies the registrants to whom it applies (doctors, PAs and AAs), and includes clear duties (e.g. honesty about role) that warn against misdescription; read as a whole it does not present a misleading legal account.
- Evidence of public confusion relates to the statutory label "associate" rather than the collective label "medical professionals"; the record did not show that the term "medical professionals" itself caused serious patient‑safety issues.
- On process, Company B conducted extensive consultation, engaged stakeholders (including Company A), tested drafts, and had rational reasons (clarity and readability) for using the term; later internal guidance urging caution did not demonstrate a pre‑decision gap or irrationality, and most internal documents post‑dated the decision.
- Applying Padfield, the court found no evidence that the use of the collective term frustrated the objectives of the 1983 Act or the AAPA Order; on the contrary, applying consistent professional standards to associates promoted those statutory objectives.
- On delay, the court treated 27 April 2023 (decision to use the term in the draft) as the relevant date; Company A did not bring proceedings promptly and did not demonstrate good reasons for extension of time, and the weak merits of the claim weighed against an extension.
- The court considered but rejected the suggestion that the appeal was academic in light of the Leng Review; the Review addressed unitary guidance rather than the single terminology issue before the court.
Holding and Implications
APPEAL DISMISSED.
Direct effect: the order of 17 April 2025 stands—Company A's substantive challenge to GMP was dismissed and the refusal to extend time to file the claim form is upheld. The court concluded that Company B's use of the phrase "medical professionals" was lawful: it was not a misdirection of law, did not induce unlawful conduct under s.49, and was not irrational or contrary to Padfield. The court treated the decision as a fact‑specific application of existing public‑law principles rather than the creation of new legal principle; no broader change to precedent was announced.
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