Thampi v General Medical Council [2026] EWHC 1036 (Admin)

Lydia Barnfather succeeds on appeal and secures the removal of an order for suspension resulting in “no action” for the doctor.

Following findings made by the Medical Practitioners Tribunal that the doctor, a Consultant in Obstetrics and Gynaecology, had failed to obtain informed consent for an instrumental delivery, failed to take into account the mother’s opposition to the use of forceps, failed to offer the option of a C-section, and had generally communicated inappropriately, the doctor’s fitness to practise was found to be impaired on the grounds of public confidence and maintaining professional standards. A sanction of three weeks’ suspension was imposed. The doctor appealed both the findings of impairment and sanction.

The appeal raised a plethora of issues and makes useful reading in relation to all five Grounds but ultimately succeeded in respect of sanction and the suspension was replaced with no order.

Ground 1 had concerned the Tribunal’s erroneous finding at the impairment stage that the patient had suffered “psychological harm”. The Court concluded that the panel had erred when it found that “psychological harm” had been caused as a result of the proved failings. There was no such allegation before the Tribunal, there was no expert evidence or relevant reasoning to support the conclusion, and the doctor was unfairly denied the opportunity to respond. The Tribunal’s error did not, however, vitiate the overall conclusion in respect of impairment given the clear gravamen of the proven failings in respect of consent and communication. Ultimately, the Court found that the Tribunal had considered the various factors required and was entitled to find the doctor’s fitness to practise impaired.

Turning to sanction, the appeal succeeded on Ground 4, which concerned the Tribunal’s  approach to the necessity for exceptional circumstances to justify no action, and Ground 5 concerning proportionality.

In respect of Ground 4, the Court held that the Tribunal’s assessment of sanction had proceeded on the erroneous basis that only exceptional circumstances justify a conclusion that no action is necessary. In reviewing the references to exceptional circumstances within the Sanctions Guidance, the court concluded that “para. 68 does not prescribe a threshold of exceptional circumstances to justify a decision not to take action”. Furthermore, the Court reiterated that the guidance is in any event  “not prescriptive but indicative”. The Court concluded that the Tribunal was wrong to have applied the threshold of exceptionality and no action following a finding of impairment can satisfy the public interest. Ultimately, a Tribunal must reach its own view of the facts of each case.

In respect of Ground 5, the unequivocal evidence before the Tribunal was that the doctor’s contract would be terminated on suspension. The Tribunal had expressed a desire that this would not be the case and imposed a relatively brief period of suspension in the hope of avoiding this consequence.  In considering sanction and weighing the doctor’s interests and the public interest, the Court found that the Tribunal had thus not properly applied the principle of proportionality. The Court stated,

“Ms Barnfather neatly encapsulated the point thus: by placing insufficient weight on the evidence and in hoping that the doctor would not be dismissed, proportionality was weighted against a hypothetical, not an actual, situation.” [para 78]

The Court concluded that, notwithstanding the seriousness of the failings, the loss of the doctor’s job would be out of all proportion to her failings. 

Main take-away points:

• The judgment reinforces the principles from R (El-Baroudy) v GMC [2013] EWHC 2894 (Admin) that the Tribunal cannot make causative findings where no allegation is pleaded;
• A finding of impairment may, on the facts of a particular case, be sufficient to satisfy the public interest. The Sanctions Guidance is not prescriptive, and, in any event, the Sanctions Guidance 2024 was not to be read as imposing a threshold of exceptionality. It is to be hoped and expected that this will be taken to apply equally to the new 2025 sanctions guidance;
• The Tribunal had queried the submission made on behalf of the doctor that any period of suspension would result in the termination of her employment, and she had been obliged to provide both oral and written confirmation in support. The fact that the Tribunal thereafter failed to give the evidence appropriate weight was therefore particularly unfortunate, but the case serves as a reminder to ensure that evidence as to the consequences of a sanction is available and that the Tribunal properly evaluates it when considering proportionality.