MPT failed to take into account doctor’s good character

A doctor’s appeal under section 40 Medical Act 1983 against findings by the Medical Practitioners Tribunal in its determination dated 8 April 2025 that she had been dishonest in making retrospective entries in respect of 14 patients at the general practice where she was then a partner, was quashed by the Administrative Court: Alam v General Medical Council [2025] EWHC 2907 (Admin)  HH Judge Jarman KC

The entries related to whether patients with chronic disease had been invited to attend an annual review.

Andrew Colman, counsel for the doctor, advanced two grounds of appeal, the first of which was that the Tribunal failed to review the overall consistency of the findings of honesty and dishonesty which were logically incoherent.

In his Lordship’s judgment, there were errors of principle in the Tribunal’s approach. The first was that it did not stand back from the minutiae and take an overview of the case on dishonesty given that it accepted that many entries were made honestly by the doctor. It was conceivable that an honest person would engage in the doctor’s task for the first time, reviewing 1000s of entries under time and other pressures over a weekend to meet a deadline, make some entries without a genuine belief in their accuracy. But this issue of probability was not considered by the Tribunal as it should have been.

The second error of principle was not to take into account the doctor’s good character or that it may make it unlikely that she would make some entries dishonestly. It was not in dispute that the chair gave a correct direction to the Tribunal that good character meant that a doctor was perhaps less likely to have committed an alleged wrong and may be more capable of belief when it came to credit. Mr Colman submitted to the Tribunal that when allegations of dishonesty were made the inherent improbability of doctors acting dishonestly must weigh in the balance. As he pithily put it, mistake was more likely than mischief.

Following that, the chair expressed the hope that that was covered in the good character direction, to which Mr Colman replied “No.” The chair then replied that she used the words “less likely” rather than “inherent probability” and continued “but yes, we agree with that approach.”

Even if that amounted to a correct direction on inherent improbability as Mr Tankel for the GMC submitted, which in the court’s judgment was questionable, that did not explain why there was no reference at all to this in the Tribunal’s determination. By far the most likely explanation was that in the intervening 15 days of deliberation the Tribunal became so immersed in detail that when it came to give its determination this factor was overlooked.

The court was therefore unable to infer from all the circumstances that it was taken into account. The unlikelihood of someone with such a good character as the doctor making dishonest entries alongside honest ones was a particularly relevant factor and the Tribunal fell into error in not taking it into account.

The unlikelihood of the doctor switching in minutes from an honest frame of mind to a dishonest one, and the unlikelihood that someone of such good character and integrity should make dishonest entries rather than mistaken ones was so overwhelmingly strong that the findings of dishonesty could not stand and must be quashed.

The second ground of appeal was that the Tribunal erred in the proper application of the burden of proof by finding dishonesty based on an absence of evidence of dishonesty.  It was not a question of whether the doctor could be “confident” that an invitation had been issued; it was a question of whether she genuinely believed that it had. Nor was it a question of whether it could be “guaranteed” that staff had followed instructions.

Again, it was a question of whether the doctor in making the entries had a genuine belief that they had. The absence of such a belief was for the GMC to prove on the balance of probabilities. The reference to giving her the benefit of the doubt “on this occasion” strongly suggested that on other occasions when there was doubt, such benefit was not given. In his Lordship’s judgment, that would be to reverse the burden of proof.

The court’s findings in relation to ground 1 were sufficient to justify the quashing of the findings of dishonesty, the consequent findings of impairment and suspension. It was not therefore strictly necessary to determine ground 2, but if it were, the court would accept the submissions of Mr Colman.