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

[2026] EWHC 1036 (Admin)Case No AC-2025-LON-002268
IN THE HIGH COURT OF JUSTICE
KING’S BENCH DIVISION
ADMINISTRATIVE COURT
Venue Royal Courts of Justice, Strand, London, WC2A 2LLDate 1 May 2026
Before
ANDREW KINNIER K.C.(Sitting as a Deputy Judge of the High Court)Dr PREMILA THAMPI
Between
THE GENERAL MEDICAL COUNCILRespondentLydia Barnfather (instructed by Clyde & Co.) for AppellantAlexis Hearnden (instructed under the General Medical Council) for RespondentHearing Hearing date: 5 February 2026Further written submissions: 10 February 2026
Approved JudgmentThis judgment was handed down remotely on 1 May 2026 at 3pm by circulation to the parties or their representatives by email and released to the National ArchivesANDREW KINNIER K.C. sitting as a Deputy Judge of the High Court:Introduction
[1]Dr Premila Thampi appeals, under s. 40 of the Medical Act 1983 (“the Act”), against two decisions of a panel of the Medical Practitioners Tribunal (“the MPT”): its finding that her fitness to practise was impaired and the suspension of her registration for three weeks.[2]There are five grounds of appeal: the first two relate to the question of impairment and the latter three concern sanction. It is said that the MPT: Ground 1(a) considered and placed weight upon an irrelevant matter, namely the purported impact on Patient A which was inappropriately classified as “psychological harm” and wrongly attributed to be the result of proved failings. Ground 2(b) failed to give appropriate consideration to various relevant factors, namely: the limited nature of the failings against Dr Thampi; the case concerned one patient and the context was unusual; the events took place more than nine years ago; the failings primarily arose from a misjudgement made in good faith; her previous good character; her prompt insight and considerable remediation. It is also said that the MPT attached insufficient weight to the fact that the complaint had been resolved by a written warning some years before and in the meantime, Dr Thampi had given exemplary public service. Ground 3(c) failed appropriately to assess the public interest. In short, although the MPT sought to correct its mistaken consideration of the psychological harm suffered by Patient A, its consideration of the public interest was inevitably contaminated by that error. In particular, the MPT failed to consider the overall context and to make a broader objective assessment of the public interest. Ground 4(d) adopted the wrong approach to the necessity of exceptional circumstances in considering whether to take no action. It is said that the MPT erroneously concluded that a threshold of exceptional circumstances existed to justify no action. Ground 5(e) failed adequately to consider proportionality. In particular, the MPT failed sufficiently to consider the undisputed written and oral evidence that any period of suspension would result in the termination of Dr Thampi’s employment. Also, the short duration of the suspension indicated that there was a marginal need for a suspension order which may indicate the MPT’s hope that Dr Thampi’s contract of employment would not be terminated. PART 1 – the relevant background Dr Thampi

PART 1 – the relevant background

[3]In 1987, Dr Thampi qualified at the University of Madras. As a junior doctor practising in India, she worked in obstetrics, gynaecology and paediatrics and was later awarded a post-graduate diploma in obstetrics and gynaecology. In May 1991, Dr Thampi came to the United Kingdom. In 1996, she became a Member of the Royal College of Obstetricians and Gynaecologists and was granted full registration by the General Medical Council (“the GMC”). In 2007, she was entered on the specialist register for obstetrics and gynaecology.

Patient A

[4]In October 2016, Dr Thampi was practising as a Consultant in Obstetrics and Gynaecology at the Milton Keynes University Hospital NHS Foundation Trust (“the Trust”). On 23 October 2016 at 7.10 p.m., Patient A was admitted to Milton Keynes University Hospital. She was at 41 weeks and 3 days’ gestation; her waters had broken and she was experiencing irregular contractions. It was her first pregnancy.[5]Dr Thampi first examined Patient A on the morning of 24 October 2016 at about 8.30 a.m. The progress of the labour was noted and a plan prepared to continue monitoring her. Patient A was later examined again by Dr Thampi and the midwife. At about 4.15 p.m., the midwife told Dr Thampi that Patient A had a raised temperature and a heightened pulse. Dr Thampi advised that Patient A should continue to be administered with intravenous fluids and antibiotics because of the risk of infection and the fact that contractions had been felt for more than a day. A plan was made for Dr Thampi to examine Patient A at 6.30 p.m.[6]The contemporaneous medical notes record that at 6.26 p.m. instrumental delivery was discussed because of the “sub-optimal” cardiotographic (“CTG”) reading. This stage in Patient A’s labour was fundamental to the later case against Dr Thampi because the principal issue before the MPT was whether at this time Patient A had consented or objected to the use of a Kiwi vacuum device (also described as a “Kiwi Ventouse” or simply as a “Kiwi”) and/or forceps. The notes recorded that consent to the use of the vacuum device was given at 6.26 p.m. and it was applied at 6.55 p.m. Forceps were later used and Patient A’s baby was born on 24 October 2016 at 7.22 p.m.[7]Dr Thampi’s post-delivery note, timed at 8 a.m. on 25 October 2016, stated that:
“… Sub-optimal CTG … Explained to Patient A/[Patient A’s mother]/partner that Patient A will need assisted birth. Explained [vaginal examination] findings + Ventouse + possible forceps. Expressed that forceps can damage a baby. Reassured that I might be able to assist the birth with Ventouse. Proceeded to Kiwi birth with consent as there was no descent beyond ++ station possibly due to maternal clinical/physical condition. Deferred further attempts with Kiwi Ventouse to avoid foetal risks. As Vx low in pelvis unable to offer caesarean section. Explained that I have to assist birth with forceps. Patient A agreed – proceeded to forceps …”
[8]Mother and baby were discharged from hospital on 27 October 2016.

Patient A’s complaint

[9]Some 18 months after the birth, on 18 July 2018, Patient A wrote a letter of complaint to the Trust. The letter is detailed but in summary Patient A said that Dr Thampi had given her insufficient information about her care. In particular, it was said that Dr Thampi had used Patient A’s fear and the fear of harm to her unborn baby to coerce consent for an instrumental delivery.[10]The complaint was considered and, following an internal disciplinary process, Dr Thampi received a first written warning.

The referral to the GMC

[11]Following the disciplinary process, on 14 February 2020, the Trust referred Dr Thampi to the GMC. The referral concerned Dr Thampi’s instrumental delivery of Patient A’s baby using a Kiwi vacuum device and forceps. It was said that Dr Thampi used the vacuum device inappropriately and thereafter she should have carried out a caesarean section. It was also said that Dr Thampi had been unprofessional towards and dismissive of Patient A who had made it clear that she did not want a forceps delivery but felt under pressure to do so. In the circumstances, it was alleged that Dr Thampi had not carried out a proper consent process.[12]On 30 May 2022, the GMC wrote to Dr Thampi to inform her of the allegations to which she responded on 13 January 2023. On 8 March 2023, the GMC notified Dr Thampi that her case had been referred to the MPT. Thereafter, the preparation of the case by the GMC took some time until the first stage of the proceedings before the MPT (namely, fact-finding) was heard in September and October 2024, just shy of eight years after Patient A’s baby was delivered. PART 2 – the Allegation and the MPT’s determinations The Allegation

PART 2 – the Allegation and the MPT’s determinations

[13]The Allegation contained the charges against Dr Thampi. By the time of the determination on the facts, it was alleged that:
“1. On or around 24 October 2016, you were involved in delivering Patient A of her baby and you failed to: a. inform Patient A that there was an increased chance of failure of operative vaginal delivery due to: i. her body mass index; ii. her inability to push as effectively because of her neuromuscular condition. b. adequately consider and/or facilitate a discussion with Patient A about the alternative options for her delivery, given the increased chance of failure of operative vaginal delivery with a vacuum device; c. act on and/or take account of Patient A’s views, when she had told you: i. on one or more occasions, she wanted a caesarean section; ii. she did not want an instrumental delivery or words to that effect; d. obtain informed consent for forceps delivery in that you: i. did not discuss with Patient A the risks and benefits of an instrumental delivery; ii. did not discuss with Patient A the risks and benefits of a caesarean section; iii. pressured Patient A into agreeing to a forceps delivery; e. appropriately respond to the lack of progress in Patient A’s delivery by not i. abandoning the vacuum delivery after three pulls; ii. immediately offering Patient A: 1. the option of transfer to theatre; 2. repeat examination following anaesthesia; 3. a caesarean section, given that Patient A had explicitly told you that she did not want a forceps delivery; h. communicate appropriately with: i. Patient A in that you stated one or more of the following: a. inform Patient A that there was an increased chance of failure of operative vaginal delivery due to: i. her body mass index; ii. her inability to push as effectively because of her neuromuscular condition. b. adequately consider and/or facilitate a discussion with Patient A about the alternative options for her delivery, given the increased chance of failure of operative vaginal delivery with a vacuum device; c. act on and/or take account of Patient A’s views, when she had told you: i. on one or more occasions, she wanted a caesarean section; ii. she did not want an instrumental delivery or words to that effect; d. obtain informed consent for forceps delivery in that you: i. did not discuss with Patient A the risks and benefits of an instrumental delivery; ii. did not discuss with Patient A the risks and benefits of a caesarean section; iii. pressured Patient A into agreeing to a forceps delivery; e. appropriately respond to the lack of progress in Patient A’s delivery by not i. abandoning the vacuum delivery after three pulls; ii. immediately offering Patient A: 1. the option of transfer to theatre; 2. repeat examination following anaesthesia; 3. a caesarean section, given that Patient A had explicitly told you that she did not want a forceps delivery; h. communicate appropriately with: 1. “no, you can’t have a c-section” or words to that effect without a discussion of risks and benefits; 2. “it is now after six o’clock and I could have gone home and let a registrar deliver your baby, but I haven’t so you need to let me do this” or words to that effect; 3. “you need to let me do this as I don’t know what is going to happen to your baby” or words to that effect. ii. Ms F [Patient A’s mother], in that you asked Ms F for consent to a forceps delivery when Patient A had capacity to consent. 2. On or around 24 October 2016 you were delivering Patient A of her baby and the degree of force you used to conduct the instrumental delivery was inappropriate.”

Stage 1 – the determination on the facts

[14]Following the hearing in September and October 2024, the determination on the facts was handed down on 2 May 2025. The MPT found that:(a) It was incumbent on Dr Thampi to inform Patient A that there was an increased chance of failure of an operative vaginal delivery due to her body mass index and her pre-existing muscular condition. That duty arose at about 6.26 p.m. on 24 October 2016 when instrumental delivery became clinically indicated. Accordingly, para. 1(a) of the Allegation was proved: para. 132.(b) Dr Thampi failed to discharge her duty adequately to consider and/or facilitate a discussion with Patient A about the alternative option for delivery in light of the increased chance of failure of an operative vaginal delivery with a vacuum device. Para. 1(b) of the Allegation was proved: paras. 148 and 149.(c) Dr Thampi should have discussed the full risks and benefits of an instrumental delivery and in the event of the use of the vacuum device failing, the need for a caesarean section which may or may not have been a “high-risk” option as much would have depended upon the descent of the baby’s head. That discussion should have happened given Patient A’s opposition to the use of forceps. The MPT rejected Dr Thampi’s evidence that it was not necessary to speak to patients about “unnecessary intervention where there is no need to” or where it is not yet clinically indicated: para. 190. Given the later finding of impairment, para. 191 of the determination should be quoted in full: “The Tribunal considered that, despite the information and explanations given by Dr Thampi to Patient A …, she had not acted on or taken into account Patient A’s views that she did not want an instrumental delivery. Dr Thampi had not offered Patient A the choice of a [caesarean section] either at 18.26 or when the Kiwi [the vacuum device] had failed, despite her indication to Dr Thampi that she did not want the use of forceps. The Tribunal considered all the evidence and determined that the sum effect of this was that Patient A was ultimately forced down the path and thus pressurised into, having to reluctantly accept, the use of forceps as the only route to deliver her baby. In all the circumstances, the Tribunal found that Dr Thampi had failed to obtain informed consent. Accordingly, it found the entirety of paragraph 1(c) and 1(d) of the Allegation proved.”(d) Having regard to the relevant guidelines, the MPT found that Dr Thampi had not failed to respond appropriately to the lack of progress in Patient A’s delivery by not abandoning the vacuum delivery after three pulls of the Kiwi vacuum. For that reason, para. 1(e)(i) of the Allegation was not proved: para. 213.(e) Dr Thampi had failed to respond appropriately to the lack of progress in Patient A’s delivery by not immediately offering a caesarean section given her statement that she did not want a forceps delivery. Consequently, paras. 1(e)(ii) and (3) of the Allegation were proved: para. 234.(f) The MPT was not satisfied that the GMC had given any reason about the specifics of the examination or why Dr Thampi had failed to respond appropriately to the lack of progress in Patient A’s delivery by not immediately offering her a repeat examination after anaesthesia. Para. 1(e)(ii)(2) of the Allegation was not proved: para. 241.(g) Dr Thampi failed to communicate appropriately with Patient A when she said “no, you can’t have a c-section” without a detailed discussion of the risks and benefits of such a procedure and without enabling or allowing Patient A to choose this option, in light of her views on the use of forceps, which linked to the failure in obtaining informed consent. Para. 1(h)(i)(1) of the Allegation was proved: para. 248.(h) The MPT was not satisfied that Dr Thampi had said “it is now after six o’clock and I could have gone home and let a registrar deliver your baby, but I haven’t so you need to let me do this” or words to that effect. Para. 1(h)(i)(2) of the Allegation was not proved: para. 258.(i) The MPT found that Dr Thampi had said that “you need to let me do this as I don’t know what is going to happen to your baby” or words to that effect. The tribunal concluded that the sentiment found to have been expressed reflected Dr Thampi’s clinical view that the use of forceps was the best course of action but that the atmosphere in the delivery room had become fraught and Patient A and her mother were shouting. Para. 1(h)(i)(3) of the Allegation was proved: paras. 272-274.(j) The MPT was not persuaded that Dr Thampi had sought Patient A’s mother’s consent for the use of forceps when Patient A had capacity. In reaching its conclusion, the MPT noted that although there were quite a few people in the delivery room, no-one else had reported that Dr Thampi had sought consent from any person other than Patient A. Accordingly, para. 1(h)(ii) of the Allegation was not proved: paras. 284-286.(k) Finally, the MPT was not satisfied that Dr Thampi had applied undue force when using the instruments. Para. 2 of the Allegation was not, therefore, established: para. 308.

Stage 2 - the determination on impairment

[15]On 8 May 2025, the MPT made its determination on impairment. The MPT reminded itself of the allegations that it had found to be proved and considered that the relevant issues were Dr Thampi’s failures to obtain informed consent and to communicate appropriately with Patient A: para. 64.[16]At para. 65, the MPT said that it had also had regard to the “impact on Patient A from the conduct it had found proved.” The determination summarised Patient A’s evidence to the effect that the experience of labour “still rules my life”; she had undergone counselling; she had sought to avoid new relationships for fear of falling pregnant again; she had decided against a career in midwifery and the trauma had delayed her making a formal complaint for 18 months after her baby’s birth.[17]The MPT considered that the proven allegations were “key ingredients to obtaining informed consent” but accepted that there were no findings of clinical negligence and the case was an isolated incident affecting one patient. That said, the MPT also concluded that the twin failures to obtain informed consent and to communicate appropriately were “serious matters, both individually and cumulatively”: para. 66.[18]The MPT directed itself to the relevant parts of Good Medical Practice (“GMP”) and the GMC’s guidance entitled “Consent: patients and doctors making decisions together” (2008) (“the 2008 Consent Guidance”) and concluded that Dr Thampi’s actions fell short of what would be proper in all the circumstances.[19]Having found that the proved facts amounted to misconduct, the MPT then considered whether Dr Thampi’s fitness to practise was currently impaired by reason of her misconduct. Although the panel recognised the absence of clinical negligence and the isolated and confined nature of the incident, nonetheless it considered Dr Thampi’s failings to be serious. In para. 77 the panel identified those factors in Dr Thampi’s favour but went on to say that:
“Patient A had been in a vulnerable position, was physically in stirrups, with a working epidural and had undergone a procedure that she did not want. It took the view that psychological harm was caused to Patient A. In line with the requirements of GMP, there had been a serious departure on Dr Thampi’s part from working in partnership with Patient A.”
[emphasis added][20]For those reasons, the MPT considered that each limb of the Grant test (summarised at para. 37 below) had been satisfied: where a doctor’s fitness to practise is impaired if she has in the past acted and/or is liable in the future to act so as to put the patient or patients at unwarranted risk of harm; and/or has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession.[21]The MPT found that Dr Thampi had insight into her actions and failures; she had carried out sufficient remediation work and that there was a low risk of repetition: para. 87. In such circumstances, the MPT considered whether the seriousness of Dr Thampi’s actions and failures justified a finding of current impairment of her fitness to practise in the wider public interest. At paras. 89-91 of the determination, the MPT said that:
“89. The Tribunal had regard to all the circumstances surrounding Patient A … and the impact of the lack of informed consent, and inappropriate communication upon Patient A. The Tribunal did appreciate that the misconduct related to one patient and was an isolated incident that Dr Thampi accepted responsibility for and that it was unlikely to be repeated. However, that had been a serious departure from the relevant sections of GMP and the GMC’s 2008 consent guidance … and it had caused a patient in a vulnerable position to undergo a procedure that she did not want. 90. The Tribunal concluded that a finding of no impairment of Dr Thampi’s fitness to practise would undermine the public interest. It was conscious that patients place trust in doctors to give them the information they need and to listen to them. The failure to obtain informed consent was serious and required a finding of impairment to mark the misconduct and necessary to maintain public confidence in the profession, and to promote and maintain proper professional standards and conduct for members of the profession. 91. The Tribunal did not consider that there was a risk to patient safety given its findings as to insight and remediation and that a finding of impairment was not required to protect, promote and maintain the health, safety and wellbeing of the public.”
[22]The MPT concluded that a finding of impairment was necessary to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of the profession. Given its finding that Patient A had suffered “psychological harm” as a result of her experience of labour, notably the panel did not conclude that impairment was necessary to protect the health, safety and wellbeing of patients.

Stage 3 - the determination on sanction

[23]On 12 June 2025, the MPT made its determination on sanction. In dealing with various preliminary points, the determination dealt with a submission made by Dr Thampi in response to the MPT’s earlier finding that Patient A had suffered psychological harm. In summary, Dr Thampi had submitted that, as the court found in R (El- Baroudy) v. General Medical Council [2013] EWHC 2894 (Admin) at para. 34, where the practitioner faced no allegation that the alleged misconduct caused any harm, the MPT could make no findings on causation when considering impairment. The Legally Qualified Chair’s advice to her fellow panel members on this question is recorded at paras. 26 and 27 of the determination:
“26. Given the reference made to El-Baroudy, the [Legally Qualified Chair] stated that Dr Thampi is obliged to meet the allegations levelled against her and no other ones. Further, that Tribunals could only make factual findings against a doctor which are based on an interpretation of events that have previously been disclosed to them and in respect of which they have been provided with adequate opportunity to investigate, call evidence and make submissions. 27. The [Legally Qualified Chair] stated that, whilst the Tribunal has had regard to the impact of the events it has found in terms of Patient A and taken a view that there was psychological harm, it should remain mindful that there had not been any allegations particularised or found in respect of psychological harm being caused as a result of the failings found. The Tribunal should be cautious and not place weight on this view when considering the issue of any sanction as that would lead the Tribunal into procedural irregularity and be unjust to the overall fairness of the case. This issue was clarified in the cause of Chauhan v GMC [2010] EWHC 2093 (Admin) and also confirmed in the case of El-Baroudy – i.e. that pursuing allegations of any causation based on misconduct should have that clearly stated in the charges and, in the absence of that, evidence directed to those issues should not be led and the Tribunal should not base its judgment on it.”
[24]There was some discussion of Patient A’s vulnerability. The panel concluded that although Patient A was in a vulnerable position because she was in stirrups and receiving an epidural, she was not a vulnerable patient. Vulnerability was not, therefore, an aggravating feature and the MPT found no other aggravating features: para. 28.[25]The MPT identified four mitigating factors: Dr Thampi’s expression of regret and remorse; her insight and remediation; the lapse of time (by then, more than eight years) since the birth of Patient A’s baby and the absence of any repetition of the proven failures or any further concerns raised about Dr Thampi’s practice during that time and the isolated nature of the incident which involved only one patient: paras. 30 and 31.[26]The MPT first considered whether to conclude the case by taking no action: paras. 32-40. The relevant parts of the determination are as follows:
“37. The Tribunal bore in mind the reference in the [Sanctions Guidance] that a departure from GMP did not automatically mean that action would be taken. It considered that GMP set out the principles, values and standards of care and professional behaviour of all doctors registered with the GMC, including working in partnership with patients. 38. The Tribunal had keen regard to the principle of proportionality, balancing Dr Thampi’s interests with the public interest. The Tribunal appreciated that Dr Thampi is otherwise a good and competent clinician and various testimonials have been provided to demonstrate this. The Tribunal referred to the mitigating factors it has identified above, and the lack of any aggravating ones. It has evaluated the seriousness of the misconduct found in respect of its findings. 39. For the avoidance of doubt, in considering its decision on sanction, the Tribunal clarified that it did not place weight on the view as to psychological harm in respect of Patient A, as referred to above in terms of El-Baroudy. 40. In light of the duties and failures established, and the departures from GMP and the Consent guidance 2008, the Tribunal did not consider there to be exceptional circumstances in this case that justified it taking no action to protect the public interest. The Tribunal determined that, in view of its findings on impairment, it would be neither sufficient, proportionate nor in the public interest to conclude this case by taking no action. The Tribunal considered that sufficient action was required in light of the seriousness of its findings. The Tribunal was of the view that there are no exceptional circumstances in this case to justify the Tribunal taking no action and did not consider that this would send a sufficient signal to the doctor, the profession and public about what is regarded as behaviour unbefitting a registered doctor.”
[27]The MPT declined to impose conditions because of the seriousness of its findings (paras. 41-45). At para. 45, the panel considered the consequences of suspension for Dr Thampi’s employment:
“… The Tribunal also appreciated the impact that anything above about the imposition of conditions on Dr Thampi’s GMC registration was likely to have on her personally and professionally in terms of the termination of her current employment contract. It did not wish this to be the case but understood the contract terms were such that this may happen if a period of suspension was imposed. The Tribunal has also heard of the likely longer-term implications on Dr Thampi’s career prospects. It noted that Dr Thampi is caring for patients at present and it considered there was a public interest in retaining and returning able clinicians to registered practice. Whilst these were matters of significant consideration for the Tribunal, it considered that the countervailing factor (which was maintaining public confidence and upholding proper professional standards and conduct for members of the medical profession) was significant and action was needed to mark the serious failings in respect of informed consent and appropriate communication.”
[28]The panel next turned to suspension of Dr Thampi’s registration. Having considered the relevant parts of the Sanctions Guidance, the panel concluded that suspension was appropriate and proportionate: paras. 51 and 52. In essence, the seriousness of its findings outweighed the absence of aggravating factors and identified mitigation. The MPT concluded, at para. 52 of the determination, that:
“It is considered that suspension would properly mark the seriousness of her misconduct and send a necessary signal to Dr Thampi, the medical profession, and the public, that such behaviour is unacceptable. The Tribunal also determined that suspension would be sufficient to uphold limbs b and c of the overarching objective, namely, to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of the profession.”
[29]In deciding the length of the suspension, the MPT sought to balance the seriousness of its findings and the mitigation advanced by Dr Thampi. It also emphasised that it had not found impairment on the ground of public/patient safety and wellbeing and had weighed Dr Thampi’s interests and the public interest: para. 55. In the circumstances, the MPT decided that a short suspension of three weeks was sufficient: para. 56.

PART 3 – the legal framework

[30]The relevant legal framework is contained in the Act, the General Medical Council (Fitness to Practise) Rules Order in Council 2004 (“the Rules”) and the GMC’s Sanctions Guidance (February 2024) (“the Sanctions Guidance”).[31]The GMC’s overarching objective in the exercise of its functions is the protection of the public: s. 1(1A) of the Act. Attainment of that objective involves the maintenance and promotion of public confidence in the medical profession and proper professional standards and conduct of members of the profession: s. 1(1B) of the Act.[32]The MPT’s role is to determine the facts, make findings on the allegations and then determine whether Dr Thampi’s fitness to practise was impaired by misconduct and, if so, to decide what sanction, if any, should be imposed.[33]Section 40 of the Act provides a right of appeal to the High Court against a sanction imposed by the MPT. It materially provides that:
“(1) The following decisions are appealable decisions for the purposes of this section, that is to say – (a) A decision of the Medical Practitioners Tribunal under section 35D above giving a direction for erasure, for suspension or for conditional registration or varying the conditions imposed by a direction for conditional registration; … (7) On an appeal under this section from a Medical Practitioners Tribunal, the court may – (a) dismiss the appeal; (b) allow the appeal and quash the direction or variation appealed against; (c) substitute for the direction or variation appealed against any other direction or variation which could have been given or made by a Medical Practitioners Tribunal; or (d) remit the case to the MPTS for them to arrange for a Medical Practitioners Tribunal to dispose of the case in accordance with the directions of this court, and may make such order as to costs … as it thinks fit.” (a) A decision of the Medical Practitioners Tribunal under section 35D above giving a direction for erasure, for suspension or for conditional registration or varying the conditions imposed by a direction for conditional registration; … (a) dismiss the appeal; (b) allow the appeal and quash the direction or variation appealed against; (c) substitute for the direction or variation appealed against any other direction or variation which could have been given or made by a Medical Practitioners Tribunal; or (d) remit the case to the MPTS for them to arrange for a Medical Practitioners Tribunal to dispose of the case in accordance with the directions of this court, and may make such order as to costs … as it thinks fit.”
[34]Appeals are by way of re-hearing: CPR PD 52D, para. 19.1. The court should allow the appeal if the MPT’s decision was wrong or unjust because of serious procedural or other irregularity: CPR 52.21(3)(a). If the court considers the MPT’s ruling to be wrong or unjust due to serious procedural irregularity or other irregularity in the proceedings below, the court may allow the appeal, substitute any decision which the MPT could have made or remit it back for further consideration.[35]The parties agreed that in Sastry and Okpara v. General Medical Council [2021] EWCA Civ 623, Nicola Davies LJ set out, at para. 102, the principles that should guide the court’s approach to the appeal:(a) Section 40 of the Act is an unqualified statutory right of appeal by medical practitioners;(b) The court’s jurisdiction is appellate, not supervisory;(c) As the appeal is by way of rehearing, the court is fully entitled to substitute its own decision for that of the MPT;(d) The appellate court will not defer to the MPT’s judgment more than is warranted by the circumstances;(e) The appellate court must decide whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate; and(f) If the latter, the appellate court should substitute some other penalty or remit the case to the MPT for reconsideration.[36]In relation to the proper approach to sanction, the court is required to make its own judgment on whether the sanction was excessive and disproportionate: Sastry, para. 110. Appropriate deference is to be paid to the MPT’s determinations in s. 40 appeals but the court must not abrogate its own duty in deciding whether the sanction imposed was wrong, that is to say, whether it was appropriate and necessary in the public interest: Sastry, para. 112.[37]As indicated in para. 20 above, a doctor’s fitness to practise is impaired if s/he has in the past acted and/or is liable in the future to act so as to put the patient or patients at unwarranted risk of harm; and/or has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession: Council for Healthcare Regulatory Excellence v. Nursing & Midwifery Council and Grant [2011] EWHC 927 (Admin), para. 76.[38]More generally, in Cheatle v. General Medical Council [2009] EWHC 645 (Admin) Cranston J held, at para. 22, that:
“In my judgment this means that the context of the doctor’s behaviour must be examined. In circumstances where there is misconduct at a particular time, the issue becomes whether that misconduct, in the context of the doctor’s behaviour both before the misconduct and to the present time, is such as to mean that his or her fitness to practise is impaired. The doctor’s misconduct at a particular time may be so egregious that, looking forward, a [tribunal] is persuaded that the doctor is simply not fit to practise medicine without restrictions, or maybe at all. On the other hand, the doctor’s misconduct may be such that, seen within the context of an otherwise unblemished record, a [tribunal] could conclude that, looking forward, his or her fitness to practise is not impaired, despite the misconduct.”

The Sanctions Guidance

[39]The Sanctions Guidance provides advice to the MPT on imposing sanctions on a doctor’s registration, including why a tribunal should impose sanctions and what factors it should consider: para. 1. Its aim is to provide a link between two regulatory roles, namely the setting of standards for the medical profession and taking action when a doctor’s fitness to practise is called into question because s/he has not met the required standards: para. 1.[40]As its title suggests, the purpose of the Sanctions Guidance is not to dictate to panels how they must proceed but to help them make fair, consistent and transparent decisions. It is indicative, not prescriptive. In other words, the Sanctions Guidance is not to be read as if it were statute: General Medical Council v. Gilbert [2026] EWCA Civ 53, para. 60; Professional Standards Authority v. Health and Care Professions Council and Doree [2017] EWCA Civ 319, para. 26.[41]The following parts of the Sanctions Guidance are relevant:(a) Para. 14, under the title “Why do we impose sanctions?”, states that the main reason for doing so is protection of the public. That objective has three elements: the protection, promotion and maintenance of the health, safety and wellbeing of the public; promotion and maintenance of public confidence in the profession; promotion and maintenance of proper professional standards and conduct for members of the profession.(b) Para. 20 is concerned with proportionality. It provides that in deciding what sanction, if any, to impose the MPT should consider the available sanctions, starting with the least restrictive. It should also have regard to the principle of proportionality, weighing the interests of the public against those of the doctor. The latter will usually be the impact on a doctor’s career. Para. 21 provides that, once the MPT has determined that a certain sanction is necessary to protect the public (and is, therefore, the minimum action required to do so), that sanction must be imposed, even where this may lead to difficulties for a doctor.(c) When the MPT decides that a doctor’s fitness to practise is impaired, it may take no action; accept undertakings from the practitioner; impose conditions on the practitioner’s registration for up to three years; suspend the practitioner’s registration for up to 12 months or erase the doctor’s name from the register (subject to certain exceptions which are irrelevant). Paras. 68-70 deal with the first option of taking no action: “68. Where a doctor’s fitness to practise is impaired, it will usually be necessary to take action to protect the public (see paragraphs 14-16). But there may be exceptional circumstances to justify a tribunal taking no action. 69. To find that a doctor’s fitness to practise is impaired, the tribunal will have taken into account of the doctor’s level of insight and any remediation, and therefore these mitigating factors are unlikely on their own to justify a tribunal taking no action. 70. Exceptional circumstances are unusual, special or uncommon, so such cases are likely to be very rare. The tribunal’s determination must fully and clearly explain: a what the exceptional circumstances are b why the circumstances are exceptional c how the exceptional circumstances justify taking no further action.” a what the exceptional circumstances are b why the circumstances are exceptional PART 4 – the grounds of appeal Ground 1: inappropriate consideration of an irrelevant factor Dr Thampi’s submissions

PART 4 – the grounds of appeal

[42]Dr Thampi’s fundamental point is that the MPT’s decision on impairment was flawed because it considered and attached weight to the purported emotional impact on Patient A which was inappropriately described as “psychological harm”. The MPT wrongly attributed such harm to the proved failings although no causative failing was alleged and the purported impact on Patient A was not that found by the MPT. In support of the submission, Ms Lydia Barnfather, counsel for Dr Thampi, relied on four particular points:(a) The description of the effect on Patient A at paras. 65 and 77 of the impairment determination (quoted in paras. 16 and 19 above) was no more than a description of Patient A’s reaction to what she saw as the deliberate and unnecessary deprivation of the natural vaginal delivery for which she had carefully planned and the non-existent (but consistently maintained) alleged permanent harm that Dr Thampi had caused her baby. In that regard, Patient A’s partly redacted correspondence (which was before the MPT) was framed in “extreme and exaggerated language”. Patient A had meticulously planned her delivery anticipating that it would be her only birth. Although it is not uncommon for mothers to feel deprived of the delivery for which they had hoped and planned, Patient A was singular in her unwillingness to recognise the accepted clinical indications for intervention.(b) The extreme nature of Patient A’s reaction to the delivery of her baby neither exacerbates the seriousness of the proved failings nor the public interest to which they give rise.(c) As there was no allegation that any failing was causative of any harm either to Patient A or her baby, there was no expert evidence on the point and Dr Thampi was denied the opportunity to answer and to challenge the MPT’s conclusion that her failings had caused psychological harm.(d) The MPT was wrong to have emphasised that Patient A was in a “vulnerable position” and found it to be an additional feature which increased the seriousness of the proved failings. In particular, it was tautological to find that those failings were aggravated by the fact that they concerned a mother in labour. The GMC’s submissions[43]In response, Ms Alexis Hearnden, counsel for the GMC, made four points:(a) The MPT was entitled to have regard to Patient A’s evidence about how she felt under Dr Thampi’s care and the lack of a working partnership. The reference to “psychological harm” is little more than a formal way of saying that Patient A was upset and distressed by what had happened. The finding did not reflect a formal diagnosis or a clinical assessment.(b) Ground 1 overstates the significance of psychological harm in the MPT’s consideration of impairment. In short, the clear gravamen of the misconduct was the communication failing which led Patient A to feel that she had no choice and the failure to obtain informed consent. Those failures justified a finding of impairment on the grounds of public confidence and standards. The MPT’s assessment of the public interest was made squarely on the basis of the gravity of Dr Thampi’s conduct and the absence of informed consent.(c) Before the MPT Ms Barnfather had accepted that although Patient A was not a vulnerable patient she was in a vulnerable position which is inherent in all mothers in labour. The MPT accepted the distinction and found that Patient A was in a vulnerable position because she was in stirrups and receiving an epidural. Therefore, the patient’s position was a legitimate aspect of assessing the gravity of the misconduct and the care which the treating doctor needs to take in such circumstances.(d) In the final analysis, the nature of Dr Thampi’s conduct was such that a finding of impairment was justified even if Patient A had been a robust and resilient patient and/or the MPT’s assessment had made no reference to “psychological harm”. A finding of impairment was inevitable: Smith v. North-Eastern Derbyshire Primary Care Trust [2006] EWCA Civ 1291. Discussion[44]Two principal issues arise: did the panel err in concluding that Patient A suffered “psychological harm”; if so, did that error vitiate the panel’s decision that Dr Thampi’s fitness to practise was impaired.[45]As to the former, four points arise in response to the panel’s finding that, at para. 77 of the impairment determination, “psychological harm was caused to Patient A”:(a) There was no allegation that Dr Thampi’s failings caused any harm either to Patient A or her baby. Consequently, no expert evidence was put before the panel on the point and no submissions were made on it.(b) The MPT did not identify (either in para. 77 or anywhere else) the evidential basis for its finding and it gave no reasons to explain its conclusion.(c) The panel did not say what it meant by “psychological harm”. Although the GMC submitted the term simply described the distress and upset that Patient A had experienced, I do not agree. The word “psychological” is suggestive of a clinical diagnosis and the term “harm” denotes “injury”. If the panel had considered that the phrase “distress and upset” fairly reflected its assessment of Patient A’s evidence, presumably, it would have used it. However, the panel chose to use a different term and one which is synonymous with a mental injury.(d) There was no expert evidence that Patient A had suffered “psychological harm” as a result of her experience of labour.[46]Although I accept that the MPT was entitled to take into account the impact on Patient A of the proven failings, nonetheless the panel erred when it concluded that Patient A had suffered “psychological harm” as a result of those failings. There was no such allegation before the MPT; there was no expert evidence or relevant reasoning to support the conclusion and Dr Thampi was unfairly denied the opportunity to respond in evidence and submissions.[47]The second issue is whether the panel’s error vitiated its overall conclusion on impairment. In my judgment, it did not. As the GMC submitted, the clear gravamen of the misconduct was Dr Thampi’s failure to obtain informed consent and to communicate appropriately with Patient A. That point was made clear throughout the impairment determination: see, for example, paras. 64, 66, 89 and 90. Likewise, the defining feature of the case was clearly articulated when the panel reached its conclusion that a finding of impairment was in the public interest: Patient A was pressured into the reluctant acceptance of the use of forceps as the only way to deliver her baby, a course for which Dr Thampi had not obtained informed consent: para. 90 of the impairment determination. Although the panel fell into error on the question of “psychological harm”, its finding of impairment was squarely based on the two proven failings and, having carefully taken into account the various positive factors in Dr Thampi’s favour, its assessment of their seriousness. I therefore accept Ms Hearnden’s submission that, for the clear reasons given at para. 90, the nature and seriousness of the two established failings warranted a finding of impairment on the grounds of public confidence and standards.[48]For the sake of completeness, I reject Ms Barnfather’s submission that the panel was wrong to emphasise that Patient A was in a vulnerable position. As Ms Hearnden submitted, the panel accepted and applied that very point that Ms Barnfather had urged upon them and which fairly reflected the situation in which Patient A found herself, that is to say, in stirrups and receiving an epidural.[49]If I am wrong and the error fatally undermined the panel’s decision in impairment, nonetheless I would have concluded that a finding of impairment was justified to maintain both public confidence and professional standards. On the basis of the facts as found proved by the MPT, the linked failures to communicate appropriately and to obtain informed consent are serious. The importance of an effective working partnership between doctor and patient is emphasised in the 2008 Consent Guidance. Good communication lies at its heart: it ensures that the treating clinician can explain the relevant risks and benefits of a particular treatment to allow the patient to make an informed decision about what to do. As the panel observed in para. 90 of its impairment determination, patients place trust in doctors to give them the information they need and to listen to them. Notwithstanding her undoubted competence and experience as a clinician, Dr Thampi did not do so on this occasion.[50]Ground 1, therefore, fails. Ground 2: failure to give appropriate consideration to relevant factors Dr Thampi’s submissions

Ground 2: failure to give appropriate consideration to relevant factors

[51]The MPT found many substantial factors in her favour: the case was an isolated incident involving one patient; there were no findings of clinical negligence; there was no history of fitness to practise concerns or findings; there was no entrenched attitude; the proved failures were remediable; Dr Thampi had apologised and remediated the concerns; there was a “vast array of positive testimonials, appraisal documentation and all patient and colleague feedback was positive” and she was considered to be a “safe, compassionate and skilled clinician with excellent communication skills” and she had insight and there was a low risk of repetition.[52]Set against those findings, the MPT attached no sufficient weight to four points: first, the proved failings arose from a misjudgement made in good faith and that Dr Thampi had the interests of Patient A and her baby throughout; secondly, the events are “exceptionally historic”; thirdly, Patient A’s complaint was resolved by the Trust with a first written warning; finally, responsibility for the delay in concluding matters lay with the GMC which had been slow to investigate and serve its case. It is said that these matters are highly relevant to public confidence in the profession. In short, the MPT placed inappropriate weight on the putative harm suffered by Patient A and insufficient weight on the four points which tended to reduce the public interest requirement for a finding of current impairment.

The GMC’s submissions

[53]Ms Hearnden submitted that it is clear that the MPT identified the relevant mitigating considerations at paras. 66 and 77 of its determination. Although the low risk of repetition was accepted, nonetheless the misconduct was considered serious because of the nature and extent of the departures from GMP and the relevant parts of the GMC’s 2008 Consent Guidance. Ultimately, a patient in a vulnerable position had undergone a procedure that she did not want.[54]Ms Hearnden made two further points: first, much of the argument now relied upon had been advanced before and considered by the MPT which had appropriately calibrated Dr Thampi’s culpability. For instance, although Dr Thampi submitted that no sufficient weight had been attached to the fact that the case was one of misjudgement in good faith, the point ignored the MPT’s rejection of the suggestion of arrogance, an entrenched attitude or bad faith.[55]Secondly, notwithstanding the argument that the case was “exceptionally historic”, no abuse of process or stay argument based on delay had ever been made by Dr Thampi. The passage of time and the point that the Trust’s investigation had resulted in a first written warning were all noted and considered by the MPT but were insufficient to alter its assessment of what was necessary to maintain public confidence.

Discussion

[56]As is clear from, for example, paras. 66, 77, 83-87 and 89 of the impairment determination, the panel was consistently careful to identify and consider the significant points which weighed in Dr Thampi’s favour. The panel consistently recognised the isolated nature of the case and the fact that it concerned only one patient; the absence of any clinical negligence; Dr Thampi’s remediation work, insight and apology; the absence of any repetition of the proven failings and the low prospect of repetition in the future. The panel also considered the substance of the many supportive references given by colleagues and others.[57]As to the particular points raised in ground 2, the MPT rejected the GMC’s submission that the misconduct was characterised by arrogance or an entrenched attitude: see para. 79 of the impairment determination. There is no suggestion that bad faith was found to be a relevant feature of the case. The panel noted the fact that the Trust’s internal disciplinary process had resulted in Dr Thampi receiving a first written warning (at para. 44) but the point was not one on which Ms Barnfather placed much emphasis or weight in her submissions to the MPT. Similarly, the panel also had regard to the time that had passed between the incident on 24 October 2016 and the start of the hearings in September 2024 and, more generally, the lengthy period it had taken to bring the matter to a hearing: para. 44. That said, as Ms Hearnden submitted, this was not a case where Ms Barnfather had sought to stay the proceedings because the delay so “exceptionally historic” as to be abusive. Also, the panel had regard to the time that had elapsed since October 2016 when considering the absence of any repetition since the incident.[58]Ultimately, the many positive significant points in Dr Thampi’s favour (as well as those raised in ground 2) were conscientiously considered by the panel. But, in the final analysis, they were outweighed by the panel’s assessment of the seriousness of the failure to obtain informed consent and to communicate appropriately with Patient A. In my judgment, for the reasons set out above, the panel’s assessment of the seriousness of the proven failings was carefully informed by the positive points relied upon by Dr Thampi and appropriately calibrated in reaching its decision that a finding of impairment was justified.[59]Accordingly, ground 2 fails. Ground 3: failure appropriately to assess the public interest in relation to sanction Dr Thampi’s submissions

Ground 3: failure appropriately to assess the public interest in relation to sanction

[60]Ms Barnfather submitted that because its assessment of the seriousness of the misconduct and the wider public interest was flawed, the MPT’s consideration of sanction was also flawed. In essence, it is said that although the MPT sought to correct its mistaken consideration of “psychological harm” by way of the Chair’s directions at the sanction stage, nonetheless its assessment of seriousness and the public interest was “in no small part driven by its mistaken consideration of the purported impact on Patient A”. Moreover, the MPT had failed to attach sufficient weight to the many positive factors in Dr Thampi’s favour.[61]In particular, Ms Barnfather contended that the public would have been aware of four relevant matters which should have been considered by the MPT: first, the failure to obtain informed consent to the use of forceps arose, on its own findings, from a misjudgement made in good faith because Dr Thampi thought that she could deliver the baby using the vacuum device and so forceps would be unnecessary; secondly, it was not found proved that Dr Thampi had been advised about Patient A’s reservations about the use of forceps before 6.26 p.m. and so there had been no contributory failures by others; thirdly, there had been some (albeit inadequate) discussion of forceps with Patient A and, importantly, Dr Thampi was found to have taken the best course of action (para. 272 of the determination on the facts); fourthly, Dr Thampi faced an “increasingly difficult and hostile environment” with Patient A and her mother who were both verbally abusive to her (para. 271 of the determination on the facts).

The GMC’s submissions

[62]Ms Hearnden’s response was three-fold: first, at stage 3, Ms Barnfather submitted to the MPT that it should refrain from consideration of “psychological harm” in its assessment of the public interest. The Legally Qualified Chair was prompted to give advice to that effect which was followed. In the circumstances, there is nothing to suggest that the assessment of the public interest was “inevitably contaminated”. Secondly, although the reasonably informed bystander was not expressly cited in its determination on sanction, the MPT identified and calibrated the seriousness of the proved failings and the need for action to mark that seriousness before turning to the public interest. Thirdly, the various mitigating factors relied upon by Dr Thampi were expressly acknowledged by the MPT in considering sanction.

Discussion

[63]Ground 3 rests on the contentions that the panel’s assessment of the seriousness of the misconduct and the wider public interest was flawed. As those contentions have been rejected, the foundation of ground 3 has mostly (but not entirely) fallen away. I should, therefore, address the principal points argued by Ms Barnfather.[64]First, no criticism is made of the substance of the Legally Qualified Chair’s advice to the panel that it should not consider “psychological harm” when assessing the public interest. Notably, there is nothing in the sanction determination that suggests that the advice was ignored in any way. In the circumstances, there is nothing in the sanction determination that supports Ms Barnfather’s submission that the panel’s assessment of the seriousness of the failings or the public interest was “driven” by its conclusion about Patient A’s “psychological harm”. On the contrary, as was the case with the impairment determination, the substance of the sanction determination shows that the panel was consistently focussed on the seriousness of the proven failings.[65]Secondly, the sanction determination followed the same approach as the impairment decision in carefully (and repeatedly) setting out the many significant factors in Dr Thampi’s favour. However, in considering the public interest the panel did not explicitly refer to the informed bystander nor did it have express regard to the four points summarised in para. 60 above. Having considered the sanction determination, in my judgment, that omission was not material. The panel had carefully considered the factors relevant to the seriousness of the conduct and identified the principal points in favour of Dr Thampi. In light of that assessment, the MPT reasonably reached the effective view that the dominant consideration was impact of the serious failing to obtain informed consent on public confidence. Given that reasonable conclusion, the four points identified in para. 60 would have made little, if any, difference in the assessment of the public interest. Ground 3, therefore, fails. Ground 4: wrong approach to necessity for exceptional circumstances in relation to sanction Dr Thampi’s submissions

Ground 4: wrong approach to necessity for exceptional circumstances in relation to sanction

[66]The MPT’s assessment of sanction proceeded on the erroneous basis that only exceptional circumstances justify a conclusion that no action is necessary. It is said that there is nothing in the Act or the Rules that require a threshold of exceptionality to be met to take no action. A finding of impairment may, on the facts of a particular case, be sufficient to satisfy the public interest. In support of her short point, Ms Barnfather relied on two relatively recent MPT decisions (GMC v. Fard and GMC v. Thompson) in which no action was considered appropriate following a finding of impairment. On the basis of those two cases, it was submitted that the MPT has applied a variable and inconsistent approach to the circumstances in which no action is justified.

The GMC’s submissions

[67]The GMC contended that the determination on sanction should be read as a whole. If that is done, the MPT plainly regarded the proved departures from GMP to be too serious to justify no action. In short, the suggestion that the threshold for no action was set too high ignores the totality of the MPT’s assessment and the “authoritative steer” given by the Sanctions Guidance: GMC v. Khetyar [2018] EWHC 813 (Admin), para. 22 per Andrew Baker J.[68]In answer to Ms Barnfather’s reliance on the Fard and Thompson decisions, Ms Hearnden submitted that care should be taken in attempting a comparative exercise in cases where the MPT had the advantage of hearing live evidence and submissions and, importantly, where the facts of the relevant misconduct will vary. Also, the mere fact that in other cases the MPT has been satisfied that a finding of impairment sends a sufficient message to the profession and the public does not undermine the MPT’s considered conclusion that a three-week suspension was required to mark the gravity of the proved failings.

Further written submissions

[69]At the end of the hearing, I asked for further written submissions on the status of the Sanctions Guidance and the parties’ views on how paras. 20 and 68 of the Sanctions Guidance interrelate (if at all). On the former, the parties helpfully drew my attention of the Court of Appeal’s decision in General Medical Council v. Gilbert [2026] EWCA Civ 53 which was handed down after the hearing. On the latter, the principal points were that para. 20 emphasises proportionality and there is no suggestion that para. 68 imposes a threshold of exceptionality when a panel is considering taking no action after a finding of impairment.

Discussion

[70]Mindful of the Sanction Guidance’s purpose (discussed at paras. 39 and 40 above), para. 68 does not prescribe a threshold of exceptional circumstances to justify a decision not to take action against a practitioner whose fitness to practise has been found to be impaired. As Ms Barnfather submitted (and I accept), para. 68 simply says that there may be exceptional circumstances which justify no action. Para. 68 reminds a panel that no action is an unusual result following a finding of impairment. Ultimately, the panel must reach its own view on the facts of each case.[71]Having carefully read para. 40 (quoted in para. 26 above) within the broader context of the sanction determination, it appears that the panel have applied a threshold of exceptionality when considering whether to take no action. Although the panel effectively observed in the second sentence that no action would not meet the seriousness of the case, the opening sentence stated that “ … the Tribunal did not consider there to be exceptional circumstances in this case that justified it taking no action to protect the public interest.” By placing exceptionality at the forefront of its reasoning, the panel appear to have applied it as a threshold and not as a reminder that such an outcome is unusual following a finding of impairment. For that reason, ground 4 succeeds.[72]Finally, I found that the Fard and Thompson decisions provided little help in deciding this case. Their facts and the proven failings were materially different from Dr Thampi’s case and Ms Hearnden was right to warn against attempting any comparative analysis. Ground 5: failure adequately to consider proportionality in relation to sanction Dr Thampi’s submissions

Ground 5: failure adequately to consider proportionality in relation to sanction

[73]Ms Barnfather contends that although the MPT paid “lip service” to the question of proportionality, it failed to take into account the undisputed evidence that any period of suspension would result in the certain termination of Dr Thampi’s employment and, given the present stage of her career, the potential curtailment of her professional life. In support, it was submitted that because of the interim conditions imposed on her registration, Dr Thampi was unable to find a permanent position but has worked under a locum contract which expressly provided for immediate termination should she lose her registration.[74]Ms Barnfather made two further points: first, instead of weighing the effect of an order of suspension on Dr Thampi and the public, the MPT said that it did not wish her employment to be terminated but that it recognised that it may happen: para. 45 (quoted in para. 27 above). The defining point, in Ms Barnfather’s submission, was that the unequivocal evidence is that the locum contract will be terminated on suspension. Therefore, proportionality appeared to have been weighed against a hypothetical, not an actual, situation. Secondly, the MPT failed properly to recognise the consequence of a suspension for Dr Thampi and failed adequately to assess the public interest in retaining her name on the register. In particular, the short duration of the suspension indicated a “very marginal need” for the order and hope that Dr Thampi’s locum contract would not be terminated.

The GMC’s submissions

[75]The GMC’s essential submission is that ground 5 rehearses matters which were put before and properly considered by the MPT. In particular, the MPT sought and heard evidence on the question whether Dr Thampi’s locum contract would be terminated in the event of an order of suspension. It also considered the question of proportionality and balanced the consequences of a suspension for Dr Thampi (which they recognised may include the end of her locum contract) with countervailing significant considerations such as the need to maintain public confidence, to uphold proper professional standards and to mark the seriousness of the proved failings. Ultimately, as Bingham MR observed in the well-known passage in Bolton v. Law Society [1994] 1 WLR 512 at 519, “the reputation of the profession is more important than the fortunes of any individual member. Membership of a profession brings many benefits, but that is part of the price.” In those circumstances, a three-week suspension was neither excessive nor disproportionate.

Discussion

[76]The question is whether the panel failed to attach sufficient weight to the fact that Dr Thampi would be dismissed if her registration was suspended.[77]Dr Thampi’s contract of employment was in evidence before the panel. Cl. 12 of the contract provides that it is a condition of her employment that Dr Thampi is and remains a fully registered medical practitioner; is included on the Specialist Register and, pertinently, continues to hold a licence to practise. The panel also had two e-mails from Mr Elvish Veeramootoo, the General Manager of Gynaecology and Obstetrics at Dr Thampi’s current hospital (both dated 9 May 2025), which stated clearly that her contract of employment would be immediately terminated if her registration were suspended. The evidence on the consequences of suspension was, therefore, unambiguous.[78]In considering sanction and weighing Dr Thampi’s interests and the public interest, the panel failed to recognise the clarity of the evidence on the prospect of dismissal should her registration be suspended. It hoped to avoid the consequences of suspension by imposing a relatively brief period but in so doing, the panel effectively ignored the stark reality as evidenced by cl. 12 of the contract and Mr Veeramootoo’s e-mails. There was nothing in the contract, the e-mails or the evidence generally to reassure the panel that Dr Thampi would not lose her job were her registration to be suspended. Certainly, the panel identified no such evidence in the sanction determination. Ms Barnfather neatly encapsulated the point thus: by placing insufficient weight on the evidence and hoping that Dr Thampi would not be dismissed, proportionality was weighed against a hypothetical, not an actual, situation. Notwithstanding the seriousness of the failings, the loss of her job would be out of all proportion to Dr Thampi’s failings especially given the significant mitigation found by the panel.[79]The MPT did not, therefore, properly apply the principle of proportionality. Ground 5 accordingly succeeds and the suspension of Dr Thampi’s registration is overturned.

Disposal

[80]I now turn to what sanction, if any, would be necessary and proportionate. The twin failures to obtain informed consent and to communicate appropriately with Patient A were serious. There is also a public interest in ensuring that professional conduct and standards require consistent compliance with the requirement of consent. I also remind myself of the statement of principle from Bolton’s case. That said, there are substantial mitigating factors that weigh heavily in Dr Thampi’s favour: the incident was isolated and involved only one patient; there were no previous concerns or findings about Dr Thampi’s fitness to practise; there was no clinical negligence; Dr Thampi has insight, she expressed a genuine apology and has carried out considerable remediation work. The incident occurred 9½ years ago since when there has been no repetition of the failings. The substance of the testimonials and appraisals relied upon by Dr Thampi is impressive. The consistent themes are her competence, her devoted care of her patients and, importantly, her excellent communication skills. I also note, once more, the evidence that suspension will result in the loss of Dr Thampi’s job.[81]On the distinctive facts of this case and reminding myself of paras. 20 and 68 of the Sanctions Guidance, the balance between the public interest and the interests of Dr Thampi is best struck by taking no further action beyond the finding of impairment. That finding is necessary, important and sufficient to emphasise the importance of obtaining informed consent to Dr Thampi, the profession and the public. I acknowledge that no action is an unusual course following a finding of impairment but the positive factors in Dr Thampi’s favour are, on any view, significant.

Conclusion

[82]Grounds 1, 2 and 3 fail: consequently, the appeal against impairment is dismissed. Grounds 4 and 5 succeed so the appeal against sanction is allowed and the suspension of Dr Thampi’s registration is overturned. Instead, no further action beyond the finding of impairment is substituted.[83]Finally, I should like to thank Ms Barnfather and Ms Hearnden for their considerable assistance and the Appellant’s solicitors for the efficient preparation of the bundles.