Professional Misconduct Cases
The GMC will refer cases to an Interim Orders Tribunal (IOT) (formerly known as an interim orders panel (IOP)) where it is deemed that a doctor’s ongoing unrestricted practice could undermine public confidence in the profession or cause harm to patients, while the GMC’s investigation into the allegations continues. Investigations can take some months and are conducted by the GMC.
Interim Orders Tribunal hearings are conducted by the Medical Practitioner’s Tribunal Service (MPTS), an independent arm of the GMC. Some doctors choose to appeal the terms of an interim order, which can be either a suspension or conditions of practice order. The IOT panel may also choose to make no order. For more information on the IOT process, see our GMC/MPTS Interim Orders Hearing Representation page. For further information about case law relevant to interim orders hearings, see below
:Interim Orders:
i. Duration of Interim Order, and
ii. Relevance of NHS Trust Disciplinary Approach
Abdullah v General Medical Council [2012] EWHC 2506 (Admin)
The High Court determined that an interim order of 18 months was excessive, and substituted an order of 12 months suspension.
The court was of the view that an investigation into sexual allegations against a doctor should not take more than 12 months. The court, however, rejected the doctor’s submissions that an interim order of suspension wasdisproportionate in all of the circumstances.
The doctor was being investigated by the GMC as a result of allegations of sexual misconduct with a patient of his GP practice.
The court held that the reasons for the interim order were sufficient and that the order was justified in order to uphold public confidence in the profession.
The court reviewed [at 24]the authorities; referring to R (Sosanya) v General Medical Council [2009] EWHC 2814 (Admin) (October 2009), the court noted the GMC/MPTS guidance to IOT panels that it is “incumbent on the panel to consider the individual features of each case and the particular charges”, and that the IOT should have in mind the possibility of the practitioner’s acquittal as well as the possibility of his or her being convicted.”
The court (in Abdullah ) observed that it was not necessary in every case to of alleged sexual misconduct to suspend a doctor. Further, where the police had chosen not to prosecute the doctor it did not mean that the GMC could not be bring allegations of misconduct. The GMC was not bound by how the PCT had approached the case. Further the allegations were not so inconsistent or vague that the GMC could not bring proceedings. (September 2012)
i. Duration of Extension of Orders, and ii. Impact of High Court Refusal to Extend Period of Suspension GMC v Dr Venugula Rao Srinivas [2012] EWHC 2513 (Admin)–
The GMC made an application to extend the interim order period, imposed on a locum GP. The High Court extended the interim order by a period of four months, to allow the GMC greater time to investigate allegations of inappropriate examinations and falsification of clinical records. It recognised that delay had also been caused (not unreasonably) because the GMC were waiting for the conclusion of criminal proceedings exploring the same allegations of inappropriate sexual behaviour toward patients.. There had been three extensions of time granted by the court previously. The court was of the view that in the event that the period of suspension were not extended by the court, that such an occurrence would amount to new circumstances. In such a case the IOT panel could consider imposing Conditions of Practice. That did not arise in the current case. (Read: Full Law Report (external link)) (September 2012)
Threshold for the Imposition of an Interim Order –
Prima Facie Case
Perry v Nursing and Midwifery Council [2012] EWHC 2275 (Admin)– Held: An interim order may be imposed by a panel using the NMC’s test of: Is there a Prima Facie case? Such a test is a fair one. A full merits hearing is not required. Article 6 is engaged and a nurse can attend the hearing. Article 8 is not engaged because of the nature of the hearing; however, if it were to be engaged the imposition of an interim order is proportionate the underlying principle of public protection. The imposition of an order out of necessity requires sufficient explanation and it was provided in the current case. The panel’s reasoning did not make it clear as to why the panel imposed an order of Conditions as opposed to The NMC guidance to panels did, however, fetter the panel’s discretion. The reference to the panel having regard to whether the nurse had an employer appears to have influenced the panel. The cooperation of an employer will rarely be necessary, especially where a nurse is not in current employment. Such an approach was an unnecessary fettering of the panel’s decision-making process. The court was not satisfied that an interim order of suspension was necessary. The Appeal was allowed. The suspension would continue until a new IOT panel could be convened within a few weeks.
The powers of the High Court (on a plain reading of Article 31(12) of the Nursing and Midwifery Order ) were construed by Counsel for the parties to not permit the judge substitute the order with conditions. The court determined that the case would need to be remitted back to a new NMC IOT panel for consideration. [Read: Full Law Report (external link)] (August 2012)
Prima Facie Case R (George) v General Medical Council (GMC) [2003] EWHC 1124 (Admin) at [42] – Findings of fact are not made by Interim Orders Tribunals (IOTs) when considering whether to make an order for public protection.
A prima facie case will be sufficient to justify an order. (May 2003) In Scholten v General Medical Council (GMC) [2013] EWHC 173 (Admin)– a doctor who had taken a photograph of a female patient’s genitals, without her permission, while she was under anaesthetic (albeit the doctor made colleagues aware at the time that it was for professional purposes), had been suspended by the MPTS/GMC Interim Orders Tribunal. The court held that, although the Interim Orders Tribunal’s view, that the doctor’s fitness to practise may be impaired [a prima facie case], the panel had insufficiently assessed the potential justifications for imposing an interim order of suspension and the impact of an ongoing suspension on the doctor. The suspension order, imposed some months before, had had a significant and detrimental impact on the doctor’s mental health, relationship with his partner, and his financial position generally. The appeal court judge’s observations would need to be considered at the next MPTS review (which was imminent) and so no quashing order was made. The judge had indicated that an interim order of conditions was suitable, as an alternative to suspension. (February 2013) High Court
Extension of Period of Interim Order
NMC v Donga (September 2012 unreported)– The NMC applied for an extension of an interim order of suspension (at the end of the statutory period in which the NMC could of its own volition impose an interim order). The High Court extended the period of the interim order by four months. The allegations were serious, relating to a nurse who had disappeared after she was questioned about her identity and whether she was a real nurse – false documents having been submitted.
Criminal Charges
Fallon v Horse Racing Regulatory Authority [2006] EWHC 2030 (Admin)– The High Court confirmed that a regulator can take into account the decision of the Crown Prosecution Service to bring criminal charges, and in having done there is a sufficient evidence on which criminal charges have been brought (prima facie test) (unreported)
In Dr Dastagir v GMC [2015] EWHC 847 an interim order of suspension was upheld on appeal, where a doctor had been charged with blackmail, in the criminal courts (unreported).
In Dr Bawa-Garba v the General Medical Council [2015] EWHC 1277 (QB) it was held that an interim order of suspension (for 18 months) was not necessary in a case where a doctor was charged with medical manslaughter, in the criminal courts.
Conditions of practise were imposed instead.
unreported) Misconceived Allegations – IOT General Medical Council (GMC) v Sheill [2006] EWHC 3025 (Admin)– A misconceived or trivial complaint should not be given weight by the Interim Orders Tribunal [35 – 36], Crane, J: “In my judgment his submissions overlook the nature of these proceedings.
They relate to an interim order. Neither the IOT nor the court is embarking on a fact-finding exercise. In my judgment the strict rules of evidence do not apply in the court hearing. Both the IOT and in turn the court must look at the allegations made against the doctor. The Panel and the court will expect the allegation to have been made or confirmed in writing, whether or not it has yet been reduced to a formal witness statement. The Panel and the court will need to consider the source and the potential seriousness of the complaint. A complaint that is trivial or clearly misconceived on its face will clearly not be given weight. The nature of the allegations will be highly relevant to the issue
whether conditions are sufficient. [35] Provision is made in the rules for evidence from the doctor. It will be relevant to note any concessions by the doctor about the truth of an allegation.
However, if an allegation is denied,
it is not the function of the Panel or the court to resolve such a dispute. The doctor’s evidence will, however, be of great importance in assessing the effect of an order on the doctor, since it is common ground that the effect on the doctor must be taken into account and a balancing exercise performed. [36]” (November 2006)
Proportionality
Madan v General Medical Council (GMC) [2001] EWHC 577 (Admin)– The Interim Orders Tribunal must take a proportionate approach to the allegations and evidence, balancing the interests of the practitioner and public protection.
Ongoing Risk –
IOT Harry v General Medical Council (GMC) [2012] EWHC 2762 (QB)Interim Order of Suspension quashed. There was no proper justification given by the panel in light of the history. The reasons given were lacking. There had been no assessment of ongoing risk and whether there was a real a risk of repetition [13-17]. Further, IOT panels should not be imposing 18 months duration of an order at the outset of a case as that was disproportionate [18]. Application by way of Part 8 CPR [2]. (October 2012)
When an Interim Order is Unnecessary –
IOT In Patel v General Medical Council [2012] EWHC 3688 (Admin) the High Court held that an interim order would be quashed where the alleged wrongdoing of a doctor (alleged conspiracy to defraud) was unrelated to clinical practice and where the absence of an interim order could not be said to create a risk to the public interest or public protection. (December 2012)
In Houshian v General Medical Council (GMC) [2012] EWHC 3458 (Admin) the High Court held that an interim order would be quashed, where a doctor had been found to have fabricated evidence in an unfair dismissal claim but where there was no properly identifiable risk to patients of his continued practise as a doctor. An interim order was disproportionate. (December 2012) IOT
Panel Reasons
In Dr EY v General Medical Council (GMC) [2013] EWHC 860 (Admin) the High Court confirmed that an interim orders tribunal panel (IOT) does not need to give detailed reasons for imposing an interim order (para 47, and see also paras 21 onwards for a discussion of case law on reasons). (April 2013)
Challenging Interim Orders in the High Court –
Extensions In General Medical Council (GMC) v Hiew [2007] EWCA Civ 369 the Court of Appeal set out the test for challenging the extension of an interim order. (April 2007)
The Public Interest
In Bhatnagar v GMC [2013] EWHC 3412 (Admin) the High Court considered how the Interim Orders Tribunal was to approach the concept of acting in the public interest. The judge opined that the panel had to ask itself what a reasonable onlooker would think if the GMC/MPTS (at the Fitness to Practise substantive stage) were to subsequently find the allegations proved, in circumstances where the Interim Orders Tribunal had not taken action, so having allowed the doctor to practise for many months. The judge held that, if a reasonable onlooker would expect the doctor to be suspended from the register, it would be legitimate for the panel to conclude it was necessary to suspend so as to maintain confidence in the profession, while the case is being investigated. [N.B. This judgment has made it more likely that a doctor will be suspended at an Interim Orders Tribunal (IOT) hearing in certain classes of cases
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