Medical Council v Grah (Approved)

Factual and Procedural Background

The Council applied under section 60 of the Medical Practitioners Act 2007 in relation to the Respondent doctor. [Para 19] The Respondent was registered in the General Division and operated a private general practice providing privately funded services only. [Para 41][Para 42]

The Respondent did not attend the hearing on 17 July 2026, although she had been called and was aware of it; the matter proceeded remotely in her absence after service was proved and a telephone call confirmed she would not attend. [Para 21][Para 24][Para 26][Para 29] The application had first been listed on 10 July 2026, when the Respondent was represented by solicitors and senior counsel, but the matter was adjourned because an issue had arisen concerning her professional indemnity insurance. [Para 22][Para 23]

The substantive concerns came from three pharmacies between March and June 2026 and related to repeated prescribing of benzodiazepines, Z-drugs and other controlled medicines in large quantities, sometimes without an apparent treatment plan and with limited engagement with pharmacists. [Para 43][Para 45][Para 48][Para 52][Para 56][Para 58][Para 59][Para 61] A later order lifted the in camera rule and allowed publication of the Respondent's identity because there was evidence she was still practising and prescribing despite the earlier orders and without professional indemnity insurance. [Para 28][Para 29]

Legal Issues Presented

1. Whether interim orders under section 60 were necessary to protect the public by suspending the Respondent's registration and prohibiting her from practising medicine pending fitness-to-practise steps. [Para 32][Para 34][Para 35]
2. Whether the concerns about prescribing practices and insurance status were sufficiently serious to justify the exceptional use of section 60, and whether any lesser measure could adequately protect the public. [Para 72][Para 73][Para 96][Para 101][Para 115][Para 132]

Arguments of the Parties

Applicant's Arguments

• The Council said the material disclosed serious concerns about high-volume and repeat prescribing of controlled drugs, large quantities, vulnerable patients, duplicate prescriptions, a lack of any clear treatment plan, and poor engagement with pharmacists. [Para 66][Para 67]
• The Council also relied on uncertainty about the Respondent's professional indemnity insurance as an additional public protection concern. [Para 108][Para 111][Para 115]

Respondent's Arguments

• The Respondent said some patients were vulnerable and had been taking the medicines before attending her practice; she said she was continuing treatment started elsewhere and intended to wean patients off gradually. [Para 68]
• She said some patients attended different pharmacies, communication could be difficult when she was busy or away, and she would seek to ensure that only one pharmacy was used. [Para 70]
• She said controlled drugs were not issued on repeat prescription through the practice website and that patients had to attend for reassessment before prescriptions issued. [Para 71]

Table of Precedents Cited

Court's Reasoning and Analysis

Judge Barniville began by stating that the principal criterion under section 60 is whether the application is necessary to protect the public, and that the court has a wide discretion but does not decide the underlying complaint or make findings of fact. [Para 85][Para 88][Para 89] He noted that suspension is an exceptional measure and that the possibility of undertakings or other lesser measures must be considered, but no undertaking had been offered or renewed by the Respondent. [Para 96][Para 99][Para 100][Para 101]

The judge treated the insurance position as a serious and independent concern. [Para 106][Para 107][Para 108][Para 109][Para 110][Para 111] He found significant public protection implications in the uncertainty surrounding the Respondent's cover, particularly because she was in private practice, and said that even that issue alone could justify interim orders pending satisfactory confirmation of insurance. [Para 113][Para 114][Para 115]

He then turned to the prescribing concerns and accepted that the pharmacy material showed repeated prescribing of controlled drugs, including benzodiazepines and Z-drugs, in large quantities and on a repeated basis, with queries from pharmacists and no clear explanation from the Respondent. [Para 118][Para 119][Para 120] Applying the O'Ceallaigh test, he held that the allegations were serious, the evidence was strong on its face, and serious sanctions could follow in later fitness-to-practise proceedings. [Para 122][Para 123][Para 124][Para 125][Para 126]

After balancing the Respondent's constitutional rights against the public interest, he concluded that the protection of patients and the public outweighed her rights to a good name, reputation and livelihood, especially given the quantities and nature of the medicines and the insurance concerns. [Para 127][Para 128][Para 129][Para 130][Para 131][Para 132][Para 133] He nevertheless granted liberty to apply to set the orders aside on notice if further evidence became available. [Para 134]

Holding and Implications

GRANTED. The court made the orders sought by the Council, including the interim suspension and related prohibitory and disclosure orders, and directed that they remain in force until further steps are taken under the Act. [Para 136][Para 137] The Respondent was given liberty to apply to set aside the orders on 72 hours' notice, liberty to apply was also granted to both parties, and costs were reserved. [Para 139] The judgment applied established section 60 principles to the facts and did not announce any new rule. [Para 85][Para 88][Para 96][Para 102]