General Medical Council & Anor v Dr Andre J Grajn [2026] EWHC 1157 (Admin)

[2026] EWHC 1157 (Admin)

Case No AC-2025-LON-004113

Case No AC-2025-LON-004125

IN THE HIGH COURT OF JUSTICE

KING'S BENCH DIVISION

ADMINISTRATIVE COURT

Venue Royal Courts of Justice, Strand, London, WC2A 2LL

Date 22 May 2026

Before

MRS JUSTICE TIPPLES DBE

Between

GENERAL MEDICAL COUNCILAppellant

PROFESSIONAL STANDARDS AUTHORITY FOR HEALTH AND SOCIAL CAREAppellant

DR ANDREJ GRAJNRespondent

IN THE MATTER OF AN APPEAL UNDER SECTION 40A OF THE MEDICAL ACT 1983

B E T W E E N:

IN THE MATTER OF AN APPEAL UNDER SECTION 40 OF THE MEDICAL ACT 1983

B E T W E E N:

DR ANDREJ GRAJN

Appellant

GENERAL MEDICAL COUNCIL

Respondent

Dr Andrej Grajn appeared in person for in person

Mr Ivan Hare KC (instructed by GMC Legal) for General Medical Council

Ms Fenella Morris KC (instructed by Browne Jacobson) for Professional Standards Authority for Health and Social Care

Hearing Hearing dates: 13 & 14 May 2026

Approved Judgment

This judgment was handed down remotely at 10.00am on 22 May 2026 by circulation to the parties or their representatives by e-mail and by release to the National Archives.

.............................

[1]On 15 October 2025 the Medical Practitioners Tribunal (“MPT”) imposed a period of twelve months’ suspension on the registration of Dr Andrej Grajn (“Dr Grajn”) and ordered a review hearing.

[2]There are three appeals in relation to the determinations made by the MPT against Dr Grajn.

[3]First, an appeal numbered AC-2025-LON-004113 brought by the General Medical Council (“the GMC”) under Section 40A of the Medical Act 1983 (“the 1983 Act”) against the sanction imposed by the MPT. The GMC’s central argument is that the sanction imposed by the MPT was insufficient to protect the public and the doctor should have been erased from the register.

[4]The GMC’s appeal is supported by the Professional Standards Authority for Health and Social Care (“the PSA”), who have filed notice under section 40B(2)-(5) of the 1983 Act seeking to be joined as an appellant, and lodged their own grounds of appeal dated 22 April 2026. The PSA’s appeal is the second appeal before the court.

[5]Third, there is then an appeal numbered AC-2025-LON-004125 brought by Dr Grajn seeking an order quashing the findings of the MPT and the sanction imposed.

[6]The parties provided the court bundles for the hearing, together with skeleton arguments.

[7]The GMC were represented at the hearing by Mr Ivan Hare KC. The PSA were represented by Ms Fenella Morris KC. Dr Grajn has attended the hearing and represented himself. The parties’ skeleton arguments were expanded on by reference to oral submissions from both Counsel and from Dr Grajn at the hearing.

Background

[8]It is first necessary to set out the facts which give rise to these appeals.

[9]Dr Grajn is a doctor who was registered with the GMC from July 2017. In 2020 Dr Grajn gained employment at the Royal Free London NHS Foundation Trust (“the Royal Free Hospital”) as a senior clinical fellow and a locum consultant in transplant surgery. Prior to this, he worked in Manchester.

[10]Dr Grajn appeared before the MPT for seven days in October 2025in relation to the following allegations:

“(1) On 13 September 2023, the Medical Board of Australia determined: (a) that you behaved in a way that constituted professional misconduct; (b) to disqualify you from applying for registration as a registered health practitioner for a period of two years; and (2) You failed to disclose the determination set out in paragraph (1) to: (a) the General Medical Council; (b) your employer, Royal Free London NHS Foundation Trust. And that by reason of the matters set out above your fitness to practise is impaired because of: (a) the determination by an overseas body that your fitness to practise is impaired, in relation to paragraph (1); (b) your misconduct, in relation to paragraph (2).” (b) to disqualify you from applying for registration as a registered health practitioner for a period of two years; and (2) You failed to disclose the determination set out in paragraph (1) to: (a) the General Medical Council; (b) your employer, Royal Free London NHS Foundation Trust. And that by reason of the matters set out above your fitness to practise is impaired because of: (a) the determination by an overseas body that your fitness to practise is impaired, in relation to paragraph (1); (b) your misconduct, in relation to paragraph (2).”

[11]I shall refer to the Medical Board of Australia in this judgment as “the Board”.

[12]The particulars of professional misconduct before the Board were that Dr Grajn failed to maintain appropriate professional boundaries with a patient and/or former patient by engaging in an inappropriate and/or sexual relationship with her.

[13]The GMC first became aware of the determination against Dr Grajn in Australia in early 2024 and found out through a press article.

The MPT’s determinations

[14]The disciplinary hearing before the MPT took place remotely between 6 and 15 October 2025. The GMC were represented by Counsel and Dr Grajn represented himself. Dr Grajn attended all days of the hearing, apart from the last day.

[15]The MPT found the facts proved against Dr Grajn in relation to all aspects of the allegation. The MPT was, it found, bound to find paragraph (1) of the allegation proved by operation of rule 34 of the General Medical Practice (Fitness to Practise) Rules 2024 (“the 2024 Rules”).

[16]The MPT determined the facts on 9 October 2025 and then turned to the question of impairment. The MPT determined impairment on 14 October 2025 and, in doing so, explained that it had “first considered whether allegation 2b, as found proved, amounted to misconduct, and if so, whether that misconduct was serious”. The MPT explained that it considered that “failing to inform his regulator and his employer, when he was fully aware of the Australian determination was a serious departure from this section of GMP [Good Medical Practice].” In doing so, the MPT found that Dr Grajn had failed to act with openness and integrity. The MPT therefore determined this was misconduct which was serious.

[17]The MPT then explained that: “In determining whether a finding of current impairment of fitness to practise is necessary, the Tribunal looked for evidence of insight, remediation and the likelihood of repetition, bearing in mind the three elements of the overarching statutory objective” (paragraph 30; page 22 of its determinations). The MPT concluded that “Mr Grajn demonstrated limited insight into the seriousness of the findings and the importance of maintaining professional standards across all jurisdictions. His responses suggested a failure to appreciate the broader aspects and responsibilities of being registered as a doctor outwith his clinical abilities and commitment (which were not in question here)” (paragraph 36; page 23 of its determinations).

[18]The MPT then “looked for evidence of any meaningful remediation that would satisfy the Tribunal and would mitigate the risk of repetition”. The evidence in this regard, such as attendance at professional development courses and testimonials provided on behalf of Dr Grajn were considered at paragraphs 37 to 47 (pages112 to 114 of its determinations), and the MPT then determined as follows: “[48.] The Tribunal applied the framework set out in [CHRE v NMC &Grant

[2011] EWHC 97

] … and was guided by the overarching objective to protect the public, maintain public confidence in the profession, and uphold proper professional standards and conduct. Taking all the factors above, the Tribunal concluded that limbs b and c of the test in Grant were met in this case, both in respect of past conduct and also on the basis of ‘being liable in the future’, and therefore there was a risk of repetition. [49.] The Tribunal found that the second and third limbs of the GMC’s overarching objective were clearly engaged in this case. The public would justifiably [be] concerned if impairment was not found in a case which a doctor failed to disclose a serious overseas disciplinary matter to the regulator. Such conduct has the potential to undermine public confidence in the medical professional and to breach the standards of integrity and openness expected of all registered practitioners. [50.] Accordingly, the Tribunal determined that a finding of impairment was necessary in order to uphold proper professional standards and conduct for the profession as a whole, and to send a clear message that such behaviour is wholly unacceptable”.

[19]The MPT explained that, having determined that Dr Grajn’s fitness to practise was impaired “by reason of determination by an overseas body and misconduct”, the Tribunal had to decide on the appropriate sanction, if any, to impose. The MPT made this determination on 15 October 2025. Dr Grajn was not present on this last day of the hearing and had emailed the MPT to say he would not be attending. Dr Grajn told the MPT that:

“I no longer intend to participate in any further sittings of this hearing. Having reviewed the Tribunal’s reasoning on impairment, I consider the process to have lost legitimacy… What remains is a form of procedural pageantry that bears no resemblance to fair adjudication. I therefore formally withdraw from further participation while expressly reserving all my statutory rights of appeal.”

[20]The MPT set out the GMC’s submissions, the relevant legal principles, and then its determination on sanction. The MPT identified that Dr Grajn’s limited insight or remediation into the matters before the Tribunal were aggravating factors, and Dr Grajn’s engagement with the proceedings at the facts stage was a mitigating factor. The MPT said that it did take into account the testimonials provided for Dr Grajn as mitigation, but afforded them little weight. The MPT then considered whether this was a case for no action, whether conditions were appropriate, whether imposing a period of suspension on Dr Grajn’s registration was the appropriate sanction, or whether this was a case for the sanction of erasure.

[21]The MPT’s expressed its decision on erasure in these terms:

“[35.] The Tribunal considered the sanction of erasure. It was not persuaded that Mr Grajn’s conduct was so difficult to remediate as to render it impossible. It did not consider that his failure in this case was reckless and noted his submission at the earlier stage that he considered the GMC were already aware of the proceedings.”

[22]The MPT’s conclusion on sanction was then explained as follows:

“[36.] Having considered all of the circumstances, the Tribunal determined that a period of suspension would appropriately reflect the seriousness of Mr Grajn’s misconduct and maintain public confidence in the profession. The Tribunal also determined that suspension would send a clear message to the medical profession that such conduct is wholly unacceptable. Furthermore, the Tribunal was satisfied that a period of suspension would serve to demonstrate to the profession the extent to which this behaviour had fallen below the standards expected of a registered doctor. [37.] Having decided that the appropriate sanction was one of suspension, the Tribunal went on to consider the length of suspension. The Tribunal determined that imposing a period of 12-month suspension was appropriate and proportionate. It was satisfied that a period of this length marked the seriousness of Mr Grajn’s departure from GMP and the extent to which that would be viewed in terms of public confidence in the medical profession. In terms of steps subsequently taken by Mr Grajn, the Tribunal noted that he had undertaken some remedial steps in terms of courses, which currently fell short of sufficient. It also noted that he has been reluctant to apologise and take full responsibility for his actions of failing to be open and inform the GMC and his employer of an overseas determination. Furthermore, a 12-month suspension would give Mr Grajn adequate time and opportunity to complete his journey of insight and remediation and show evidence of such to a review hearing to enable him, in due course, to return to practise unrestricted.”

[23]The MPT determined to direct a review of Dr Grajn’s case, to convene shortly before the end of the period of suspension. Finally, the MPT determined it was necessary to make an immediate order.

The decision of the Queensland Civil and Administrative Tribunal

[24]Before turning to the parties’ grounds of appeal, it is necessary to explain what happened in the proceedings in Australia in relation to Dr Grajn.

[25]The hearing in Case OCR153-22 between the Board (Applicant) and Andrej Grajn (Respondent) took place on 13 September 2023 before the Queensland Civil and Administrative Tribunal (“QCAT”). QCAT comprised a Judicial Member J Robertson (“the judge”) who was assisted by three panel members, namely Prof P Baker and Dr J Cavanagh, Medical Practitioner Members, and Ms M Ridley, Public Panel Member.

[26]QCAT made a decision on 13 September 2023, and handed down their written judgment with reasons on 17 November 2023: Medical Board of Australia v Grajn [2023] QCAT 433.

[27]The order of 13 September 2023 is sealed by the Court, signed by the judge, and says this:

“IT IS THE DECISION OF THE TRIBUNAL THAT: 1. Pursuant to s 196(1)(b)(iii) of the Health Practitioner Regulation National Law (Queensland) (the National Law), the respondent has behaved in a way that constitutes professional misconduct. 2. Pursuant to s 196(2)(a) of the National Law, the respondent is reprimanded. 3. Pursuant to s 196(4)(a) of the National Law, the respondent is disqualified from applying for registration as registered health practitioner for a period of 2 years”

[28]The respondent referred to at paragraphs 1, 2 and 3 of the order is Dr Grajn.

[29]The judgment of QCAT records that Dr Grajn did not appear at the hearing on 13 September 2023.

[30]It is necessary to refer to a number of different paragraphs in QCAT’s written decision. The background is set out in paragraphs 1 to 11:

“[1] On 20 June 2022, the Medical Board of Australia (‘the Board’) referred a disciplinarymatter to the Tribunal which contained one allegation against the respondent, aregistered medical practitioner at all relevant times; namely, that he engaged inprofessional misconduct in that between February 2016 and on or about 2 September2017, he failed to maintain appropriate professional boundaries with a patient and/or former patient, HBM, by engaging in an inappropriate personal and/or sexualrelationship with her. [2] The respondent is an overseas trained medical practitioner, having obtained hismedical qualifications in Slovenia in 2005. At all relevant times, he held limitedregistration with the Board and was practicing as a transplant surgical fellow in therenal transplant team at Princess Alexander Hospital (‘PAH’). He was a member ofthe surgical transplant team when HBM underwent renal transplant surgery at thePAH on 10th February 2016, when she received a donor kidney from her then partnerGW. [3] As at the date of the hearing on 13th September 2023, the respondent was unregisteredin Australia, but registered as a specialist urologist with the General Medical Councilin the United Kingdom. [4] The respondent left Australia in February 2017. [5] On 12 October 2017, HBM died by suicide in the most horrific of circumstances. Anumber of the Boards’ witnesses draw a link in their statements between therelationship with the respondent and HBM’s death. It is clear that on the evidence, thetragic death of this very capable and much-loved woman was as a result of severemental distress in the last months of her life. It is clear that this distress was in someway connected with her relationship with the respondent. The Board submits that the“effect the relationship had on HBM’s mental state and [her] tragic end are testamentto why professional boundaries between medical practitioners and patients and formerpatients must be maintained.”

That submission will be considered later in thesereasons. [6] In October and November 2017, the Office of the Health Ombudsman (“OHO”) received notifications concerning the alleged boundary respondent’s former employer and GW. [7] On or about 23 March 2018, the Australian Health Practitioner Regulation Agency(Ahpra) received from the respondent, an application for limited registration forpostgraduate training or supervised practice. The respondent intended to practise atthe Royal Darwin Hospital. [8] On or about 19 June 2018, the OHO informed the respondent of its decision toinvestigate both notifications, and, on 18 September 2018, the respondent withdrewhis application for registration and has not reapplied for registration since. Therespondent is contactable by email, but it is not known where he is presently residingand/or practicing apart from the GMC registration details. [9] On or about 24 December 2018, the OHO informed the respondent that the matter hadbeen referred to Ahpra for management by the Board. [10] Following an investigation into the notifications, on or about 28 March 2022, theBoard decided to refer the matter to the Tribunal under section 193B(2) of the NationalLaw, having formed a reasonable belief that the practitioner had behaved in a waythat constitutes professional misconduct. [11] The respondent has not been legally represented during the investigation and since thefiling of the referral. He denies any inappropriate relationship with HBM. He admitsthat he and HBM became friends after the surgery but asserts that the friendship was“as two private adult consenting individuals”, and (in effect) disputes the right of theBoard to take disciplinary action against him.”

[31]The assessment of the evidence of the Board starts at paragraph 12 of the judgment. The judgment explains that the Board had the onus of proving the facts that underpinned the allegation in the referral. The judgment records that Dr Grajn was given the opportunity to test the evidence of the Board at the hearing, but he declined to do so, asserting in an email dated 11 September 2023 that “he denied any misconduct and accused the Board of conducting its investigation with “punitive zeal and bias””.

[32]The judgment sets out that Dr Grajn denied that he had behaved inappropriately or otherwise acted in a way that constitutes professional misconduct, but he had made numerous concessions as to the extent of his relation with HBM (paragraph 15). At paragraph 17 of the judgment

the judge says:

“In my opinion, a fair analysis of the Board’s evidence overwhelmingly establishes to the relevant standard, that the admitted relationship with HBM was inappropriate from soon after surgery and developed into a sexually intimate relationship during the relevant period.”

[33]As to the evidence,

the judge said:

“[19] I am satisfied that the Board has proved these facts to the relevant standard. I rejectthe respondent’s many contentions to the effect that the relationship between he andHBM was not sexually intimate. I reject his recent contention that their “friendship”happened a year after the surgery. Not only is that inconsistent with the evidence I doaccept, but it is also inconsistent with the concessions made by the respondent inearlier communications with regulators. [20] The evidence summarized above establishes that the respondent permitted aninappropriate relationship to develop very soon after the surgery. I am satisfied thatby the time of the trip to Canberra in February 2017, a sexually intimate relationshipwas established. I am satisfied that almost immediately after the surgery, therespondent behaved in a way that indicated a clear sexual interest in HBM. It isprobable that he acted on that interest well before the Canberra trip and during 2016.”

The judge then expressed his conclusions in these terms:

“[25] I am satisfied that the respondent’s breach of professional boundaries is bothsubstantially below the standard expected of a registered health practitioner of anequivalent level of training or experienceand conduct that is inconsistent with beinga fit and proper person to hold registration… [26] As noted above, the Tribunal is satisfied that an inappropriate relationship wasinitiated by the respondent while HBM was still recovering from the surgery inhospital. The evidence establishes that she trusted him and held him in high regard atthat time. Not only did he not appreciate the unethical and unprofessional nature ofhis conduct from the outset, throughout the investigation, he revealed a complete lackof understanding of the importance of not exploiting a patient, and then a formerpatient, leading to a sexual relationship which clearly had a profound effect on her,but which he regarded as unimportant.”

[35]The judge then turned to sanction. In determining the appropriate sanction, the judge reminded himself of Psychology Board of Australia v Popovski [2019] VCAT 155. In that case the practitioner was not registered at the time of the hearing and had not practised for three years. The Tribunal found that the practitioner had engaged in professional misconduct, and reprimanded the practitioner and ordered a disqualification period for three years.

[36]The findings and orders made against Dr Grajn by QCAT on 13 September 2023, and as set out at paragraph 27 above, were then set out in the final paragraph of the judgment.

The appeals

[37]I now turn to the appeals before this court. It is convenient to consider to Dr Grajn’s appeal first. Dr Grajn’s appeal

[38]Dr Grajn’s appeal is brought under section 40(1)(a) of the 1983 Act.

[39]There is no dispute that the correct approach to such appeals is set out in Sastry & Okpara v General Medical Council

[2021] 1 WLR 5029

per Nicola Davies J at [101] to [105]:

“[101.] The breadth of the section 40 appeal and the appellate nature of the court’s jurisdiction was recognised by the Judicial Committee of the Privy Council in Ghosh [2001] 1 WLR 1915 … [102.] Derived from Ghosh are the following points as to the nature and extent of the section 40 appeal and the approach of the appellate court: (i) an unqualified statutory right of appeal by medical practitioners pursuant to section 40 of the 1983 Act; (ii) the jurisdiction of the court is appellate, not supervisory; (iii) the appeal is by way of a rehearing in which the court is fully entitled to substitute its own decision for that of the Tribunal; (iv) the appellate court will not defer to the judgment of the Tribunal more than is warranted by the circumstances; (v) the appellate court must decide whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate; (vi) in the latter event, the appellate court should substitute some other penalty or remit the case to the Tribunal for reconsideration. [103.] The courts have accepted that some degree of deference will be accorded to the judgment of the Tribunal but, as was observed by Lord Millett at [34] in Ghosh, “the Board will not defer to the Committee’s judgment more than is warranted by the circumstances”

. In Preiss, at [27], Lord Cooke stated that the appropriate degree of deference will depend on the circumstances of the case. Laws LJ in Raschid and Fatnani, in accepting that the learning of the Privy Council constituted the essential approach to be applied by the High Court on a section 40 appeal, stated that on such an appeal material errors of fact and law will be corrected and the court will exercise judgment but it is a secondary judgment as to the application of the principles to the facts of the case ([20])… [105.] It follows from the above that the Judicial Committee of the Privy Council in Ghosh, approved by the Supreme Court in Khan, had identified the test on section 40 appeals as being whether the sanction was “wrong” and the approach at the hearing, which was appellate and not supervisory, as being whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate.”

Dr Grajn’s grounds of appeal

[40]Dr Grajn challenges the MPT’s findings on impairment and sanction and advances five grounds of appeal. These are set out in his appellant’s notice:a. Ground 1 – Lack of jurisdiction: The MPT acted ultra vires under section 35C(2)(e) of the 1983 Act by relying the QCAT decision when he was not registered in Australia and expressly declined to examine that jurisdictional issue.

b. Ground 2 – Rule 34 of the Rules 2024/Good Medical Practice, paragraph 75 Misdirection: The MPT treated the foreign certificate as conclusive and wrongly extended disclosure duties to a non-existent registration, creating an artificial finding of misconduct.

c. Ground 3 – Grant Test Misdirection: Having accepted there was no patient risk and no dishonesty, the MPT relied on abstract “public confidence” to justify impairment, reversing the protective sequence of Grant and “substituting moral theatre” for legal analysis. Dr Grajn’s reference to the “Grant test” is to the guidance provided by Dame Janet Smith in Shipman (5th Report) at paragraph [76] of Council for Healthcare Regulatory Excellence v

(1) Nursing and Midwifery Council;

(2) Paul Grant

[2011] EWHC 927 (Admin)

, Cox J (“CHRE v Grant”).

d. Ground 4 – Sanction and Immediate

[41]Grounds one and two are points of law. Grounds three, four and five relate to evaluative determinations of the MPT.

[42]I have to consider whether there are any material errors of fact or law which require correction, and I have to exercise my own judgment, which is a secondary judgment as to the application of the relevant principles to the facts of this case. In relation to the sanction imposed by the MPT (ground 4), I have to consider whether it was appropriate and necessary in the public interest or was excessive and disproportionate. I will deal with each ground in turn.

Ground 1

[43]This grounds relates to the application of, and jurisdiction of, the MPT under section 35C(2)(e) of the 1983 Act and rule 34 of the2004 Rules.

[44]Section 35C of the 1983 Act provides, so far as material, that:

“(1) This section applies where an allegation is made to the General Council against – (a) a fully registered person; or (b) a person who is provisionally registered, that his fitness to practice is impaired. (2) A person’s fitness to practice shall be regarded as “impaired” for the purposes of this Act by reason only of – (a) misconduct; … (e) a determination by a body in the United Kingdom under any enactment for the regulation of a health or social care profession to the effect that his fitness to practise as a member of that profession is impaired, or a determination by a regulatory body elsewhere to the same effect.”

[45]It is also necessary to set out rule 34 of the 2004 Rules which provides, under the heading, “Evidence”: (1) The Committee or a Tribunal may admit any evidence they consider fair and relevant to the case before them, whether or not such evidence would be admissible in a court of law. … (4) Production of a certificate signed by an officer of a regulatory body that has made a determination about the fitness to practise of a person shall be conclusive evidence of the facts found proved in relation to that determination. (5) The only evidence which may be adduced by the practitioner in rebuttal of a conviction or determination certified in the manner specified in paragraph (3) or (4) is evidence for the purposes of proving that he is not the person referred to in the certificate or extract.”

[46]The MPT held that “with the evidence available, the Tribunal was satisfied that [the Board] had determined that Mr Grajn had behaved in a way that constituted professional misconduct and that he was disqualified from applying for registration as a registered health practitioner for two years”. The MPT found that it had “no discretion outside the parameters set by rule 39” (paragraph 38; page 9 of its determinations). The reference to rule 39 was an erroneous reference to rule 34, as the MPT had referred to rule 34 in the previous paragraph when it had observed: “Rule 34 does not require the GMC to re-prove those facts …”.

[47]Dr Grajn submits that the statutory “gateways” to find impairment are set out in section 35C(2) of the 1983 Act and, in his case, the criteria identified in section 35C(2)(e) were not made out. This is because the QCAT decision in September 2023 was made several years after he had ceased to be registered in Australia and, as such, this was not a determination of his “fitness to practise as a member of that profession is impaired” within the meaning of section 35C(2)(e) of the 1983 Act. Dr Grajn says his point is simple: the impairment jurisdiction cannot be derived from a foreign registration that did not exist at the time of the foreign decision. In addition to, that Dr Grajn submits that rule 34 of the 2004 Rules may permit evidence from other proceedings to be admitted, but it is not a substitute for the statutory gateway under section 35C(2)(e).

[48]Mr Hare KC for the GMC submits that QCAT was well aware that Dr Grajn was no longer registered at the date of its decision. It was for that reason that QCAT chose the sanctions of reprimand and disqualification from applying for registration for two years from 13 September 2023 and those are sanctions which are expressly made available for practitioners who are no longer registered. The decision was therefore within the powers of QCAT and the QCAT decision plainly fell within the ambit of section 35C(2)(e) of the 1983 Act.

[49]By a letter dated 8 September 2017, Dr Grajn was informed by the Australian Health Practitioner Regulation Agency that their records showed that he had not renewed his Limited Medical Practitioner registration and, with effect from 7 September 2017, he had been removed from the Register of Practitioners.

[50]QCAT was aware that Dr Grajn was unregistered at the date of the hearing on 13 September 2023 and their decision records that he had left Australia in February 2017, which was some months before his registration had lapsed. However, the allegation before QCAT related to a time when Dr Grajn was registered in Australia, namely between February 2016 and on or about 2 September 2017. QCAT found that Dr Grajn “has behaved in a way that constitutes professional misconduct”, which is recorded in the order made and sealed by QCAT on 13 September 2023. That order was also signed by the judge. There was no issue between the parties that signed and sealed order was a certificate within rule 34(4) of the 2004 Rules. As such, that order is conclusive evidence of the facts found proved in relation to that determination, which are set out in QCAT’s judgment delivered on 17 November 2023.

[51]There is no issue that QCAT is a regulatory body responsible for the regulation of a health or social care profession elsewhere than the UK, ie Queensland, Australia. QCAT’s determination on 13 September 2023 that Dr Grajn “has behaved in a way that constitutes professional misconduct” is, and must be, a determination by a regulatory body elsewhere than the UK to the effect that Dr Grajn’s fitness to practice as a member of the health or social care profession, namely as a doctor, is impaired. In these circumstances that is a determination which falls within the ambit of section 35C(2)(e) of the 1983 Act. The fact that Dr Grajn was not registered as a doctor in Australia when QCAT made its decision is neither here nor there.

[52]Further, the production of QCAT’s sealed and signed order made on 13 September 2023, coupled with the effect of rule 34(4) of the 2004 Rules, means that MPT was correct find allegations 1(a) and (b) proved against Dr Grajn (paragraph 41; page 9 of MPT’s determinations). There was no error of law or fact on the MPT in making this determination.

[53]Accordingly, Dr Grajn’s first ground of appeal fails.

Ground 2

[54]Paragraphs 75 and 76 of the Good Medical Practice (“GMP”) provides:

“[75.] You must tell us without delay if, anywhere in the world: … (c) another professional body has made a finding against your registration as a result of fitness to practise procedures. [76.] If you are suspended by an organisation from a medical post, or have restrictions placed on your practice, you must, without delay, inform any other organisations you carry out medical work for and any patients you see independently.”

[55]Dr Grajn submits that, in relation to paragraph 75, the words “against your registration” are limiting words which identify “the object of the foreign finding” and there is no duty imposed to report every adverse foreign decision. Rather, the duty imposed is to report a finding against a registration or licence to practise and paragraph 76 is consistent with that interpretation. Dr Grajn maintains that, by September 2023 he had no existing registration or licence in place in Australia, as it had lapsed in September 2017. There was therefore no registration or licence against which a finding could be made and he was not under any obligation to report the decision of QCAT on 13 September 2023 to the GMC.

[56]The problem with this submission is that, whilst Dr Grajn is correct that he was not registered as a doctor with the Board in September 2023, he was registered with the Board when he committed the professional misconduct which led to the fitness to practise proceedings against him. Further, the decision of QCAT was that Dr Grajn had behaved in a way that constituted professional misconduct when he was registered as a doctor in Australia, and the sanction imposed was to disqualify him from re-applying for registration for a period of two years from 13 September 2023. The decision of QCAT is therefore a finding against Dr Grajn’s registration as a result of fitness to practise procedures and falls within the ambit of paragraph 75(c) of the Good Medical Practice. Dr Grajn was aware of the determination of QCAT on 18 September 2023 and, once he was aware of it, he was obliged to tell the GMC about it without delay. He failed to do this and the MPT was entitled to find paragraph (2)(a) of the allegation proved.

[57]Dr Grajn’s second ground of appeal fails.

Ground 3

[58]In CHRE v Grant Cox J said the following in relation to impairment: “[76.] I would also add the following observations in this case having heard submissions, principally from Ms McDonald, as to the helpful and comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman, referred to above. At paragraph 25.67 she identified the following as an appropriate test for panels considering impairment of a doctor’s fitness to practise, but in my view the test would be equally applicable to other practitioners governed by different regulatory schemes. “Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:(a) has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

(b) has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

(c) has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or

(d) has in the past acted dishonestly and/or is liable to act dishonestly in the future. The value of this test, in my view, is three-fold: it identifies the various types of activity which will arise for consideration in any case where fitness to practise is in issue; it requires an examination of both the past and the future; and it distils and reflects, for ease of application, the principles of interpretation which appear in the authorities. It is, as it seems to me, entirely consistent with the judicial guidance to which I have already referred, but is concisely expressed in a way which is readily accessible and readily applicable by all panels called up to determine this question.” “Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he: (a) has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or (b) has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or (c) has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or (d) has in the past acted dishonestly and/or is liable to act dishonestly in the future.

[59]Dr Grajn submits that the MPT misapplied the guidance provided at paragraph 76 of CHRE v Grant as the MPT was required to assess current impairment, future risk, remediation, insight, public confidence and professional standards in a structured and protective manner. Dr Grajn argues that the relevant features are that(a) there is no current patient safety concern;

(b) no finding of dishonesty;

(d) there has been “sustained safe UK practice”;

(e) there is supportive testimonial evidence and substantial evidence of good practice on his part; and

(f) there are disputed legal issues arising under section 35C(2)(e) of the 1983 Act and paragraphs 75 and 76 of the GMP. Dr Grajn maintains that the MPT’s reasoning is circular because, as he did not accept the MPT’s analysis of the law, he lacked insight and therefore public confidence required a finding of impairment. In addition to that, the MPT failed to identify what future conduct was realistically liable to be repeated and its approach was contrary to Sawati v General Medical Council

[2022] EWHC 283 (Admin)

, Collins Rice J (“Sawati”). Dr Grajn submits that the MPT’s determination of impairment that his failure to disclose “a serious overseas disciplinary matter to the regulator” has the potential to undermine public confidence in the medical profession is completely wrong. He argues that this ground alone is sufficient to require the impairment finding to be quashed.

[60]Mr Hare KC for the GMC submits that CHRE v Grant at paragraph [76] merely provides helpful illustrations of the different ways in which a practitioner’s fitness to practise may be found to be impaired. The examples provided having been devised by Dame Janet Smith in the Shipman Inquiry (5th Report). The MPT found that limbs (b) and (c) of CHRE v Grant were made out and Dr Grajn’s lack of insight into his misconduct was a matter that the MPT was fully entitled to take into account when considering current impairment and future risk.

[61]The MPT determined impairment on 14 October 2025. The determination of impairment is expressed by reference to allegation 2(b), which the MPT determined was serious misconduct. The fact the MPT did not refer to allegations 1(a) and (b) at this stage of its determinations is the GMC’s first ground of appeal.

[62]The MPT correctly identified the question it had to decide, referred in detail the submissions made by both the GMC and Dr Grajn, reminded itself of the evidence (and had had the benefit of hearing oral evidence from Dr Grajn) and directed itself to the relevant legal principles by reference to CHRE v Grant. The MPT also reminded itself of Sawati and said “the starting point being that doctors are properly and fairly entitled to defend themselves, so Mr Grajn’s denial of the facts did not impact on the decision”.

[63]The MPT looked for evidence of insight, remediation and the likelihood of repetition and, at paragraphs 31 to 47 (pages 22 to 25 of its determinations), summarised the evidence before it with respect of each of these matters. The MPT acknowledged the testimonials provided on behalf of Dr Grajn described him as a “conscientious and capable clinician” and accepted that “there were no concerns regarding his clinical competence or the quality of care he provides to patients while practising in the UK” (paragraph 46; page 25 of its determinations). The MPT acknowledged that these testimonials spoke “positively of his abilities and character in the workplace” but the MPT considered “that they did not address the concerns regarding his lack of insight and failure to fully accept responsibility for the events that led to these proceedings”. The MPT took all these factors into account, applied the framework set out in CHRE v Grant and concluded that “limbs (b) and (c) of the test in Grant were met in this case, both in respect of past conduct and also on the basis of “being liable in the future”, and therefore there was a risk of repetition”.

[64]In my view, there are no errors of law or fact in this approach by the MPT. Indeed, it would have been wrong for the MPT to adopt a blinkered approach of only looking at what had been said in relation to the Dr Grajn’s clinical abilities in the UK. Rather, it was critical to assess all the evidence before them in order to determine whether Dr Grajn had demonstrated any insight into his misconduct, or accepted any responsibility for what he had done. This was because the MPT had to assess whether, if Dr Grajn had acted in a particular way in the past, he was likely to do so in the future and therefore what the future risk was. They MPT were right to take this approach, and there was ample evidence to demonstrate that Dr Grajn had shown limited insight in relation to his misconduct and was reluctant to accept responsibility for what he had done.

[65]In these circumstances, Dr Grajn’s third ground of appeal fails.

Ground 4

[66]Dr Grajn submits that the sanction imposed by the MPT was disproportionate and inadequately reasoned and the MPT were wrong to impose this sanction in circumstances were there was(a) no current or foreseeable patient-safety risk;

(b) no finding of dishonesty;

(d) supportive testimonial evidence;

(e) the alleged failing arose from a disputed legal duty. The MPT was required to impose the least restrictive sanction sufficient to meet the statutory objective and it failed to explain why no order, warning, conditions or a shorter suspension period would have been insufficient. Dr Grajn maintains that the “sanction reasoning was formulaic and failed to reconcile suspension with the absence of current risk, absence of dishonesty, absence of clinical concern and sustained safe practice.” Further, Dr Grajn submits that the immediate order was unlawful as it required a separate assessment of necessity, and no adequate explanation was provided was to why immediate suspension was necessary pending an appeal when there was no current patient-safety concern. Accordingly, Dr Grajn submits that the sanction and immediate order were punitive in effect and should be quashed.

[67]Mr Hare KC for the GMC submits that, in relation to the MPT’s approach to sanction, there is no material error of fact or law. The MPT did have regard to the Sanctions Guidance (in use from 5 February 2024), considered sanctions on an increasing level of seriousness, discounted erasure as the appropriate sanction and did not impose a sanction which was excessive or disproportionate (paragraph 35; page 33 of its determinations). Mr Hare KC submits that Dr Grajn is unable to challenge the immediate order as he has not made a statutory application for termination under section 38(8) of the 1983 Act, which requires the commencement of separate proceedings under CPR Part 8 (see Oyesanya v General Medical Council

[2018] EWHC 338 (Admin)

, Philip Mott QC (sitting as a Deputy Judge of the High Court) at [3], and [11] to [13]).

[68]Dr Grajn chose not to be present on 15 October 2025 when the MPT determined sanction. The MPT took into account all the evidence received at the earlier stages of the hearing, had regard to the GMC’s submissions, aggravating and mitigating factors and the Sanctions Guidance. They assessed Dr Grajn’s conduct as serious and considered the appropriate sanction starting at the lowest level on the scale. The MPT concluded that Dr Grajn had the capacity to remediate, noted “his engagement in the process to date” and that he was “entitled to reject the factual allegations and dispute his impaired fitness”. The MPT said that “whilst the lack of insight has persisted to these proceedings” there was evidence that Dr Grajn had indicated to colleagues “he should have acted differently” and the MPT did not consider the risk of repetition to be significant (paragraph 33; page 33 of the determinations). In these circumstances, and having considered paragraphs 91 to 97 of the Sanctions Guidance, I have concluded that the MPT’s decision to suspend Dr Grajn for a period of 12 months, with a review, cannot be characterised as excessive.

[69]As to the determination that Dr Grajn should be immediately suspended, it is for the doctor to be proactive in challenging such an order if he feels that safeguards put in place for the protection of the public are unfair to him. Dr Grajn has not made any application to the court under section 38(8) of the 1983 Act and, on hearing his appeal, the court does not have jurisdiction to consider this issue. However, even if it did have jurisdiction, it is not a determination that in the circumstances of this case I would have interfered with.

[70]Dr Grajn’s fourth ground of appeal fails.

Ground 5

[71]Dr Grajn submits that the MPT wrongly treated his litigation stance as lack of insight. He submits that Sawati is central to that error as it “prevents a tribunal from converting the legitimate defence of allegations into lack of insight unless the defence is shown to involve something materially more serious, such as deliberate falsehood, manufactured denial, or an evidenced attitudinal risk”. Dr Grajn submits that the MPT’s approach “conflated robust legal defence with character defect. That was procedurally unfair and contrary to Sawati”.

[72]The MPT reminded themselves of Sawati (paragraph 24; page 21 of the MPT’s determinations). However, Sawati did not preclude the MPT from considering and evaluating all the evidence before them in relation to Dr Grajn’s insight into his misconduct. On that evidence, it was open to the MPT to conclude that Dr Grajn “focussed on procedural issues rather than on his own responsibilities or the potential impact of his behaviour on public confidence in the profession” and “challenging the process” (paragraphs 35 and 43; pages 23 & 24 of the MPT’s determinations). I agree with the submission of the GMC that there was ample evidence upon which the MPT could reach its conclusion about Dr Grajn’s insight into his misconduct as set out in the MPT’s determination on impairment and sanction.

[73]Dr Grajn also submits in this ground that the MPT failed to engage with his submissions and failed to explain why the MPT rejected his arguments. This is a catch-all and does not add any further to Dr Grajn’s first to fourth grounds of appeal.

[74]Dr Grajn’s fifth ground of appeal fails. Conclusion:

Dr Grajn’s appeal

[75]Dr Grajn’s appeal is dismissed.

GMC & PSA’s appeals

[76]There is no dispute as to the relevant law which applies on an appeal of this nature by the GMC. This is contained in section 40A of the Medical Act 1983; General Medical Council v Jagjivan & Anor

[2017] EWHC 1247 (Admin)

; 1 WLR 4438 at paragraphs [39-40]; and Bawa-Garba v General Medical Council

[2018] EWCA Civ 1879

;

[2019] 1 WLR 1929

at paragraphs [61], [63], [67] and [94]. These two cases are well known and there is no need for me to cite from them. However, it is important to emphasise that, on appeal of this nature, against the decision of a professional Tribunal, this court has to proceed with considerable caution before interfering with such a decision. That of course does not mean that, in an appropriate case where the Tribunal is wrong, this court cannot interfere.

[77]I can take the law in relation to the PSA’s appeal from Ms Morris KC’s skeleton argument as the principles are not in dispute.

[78]Where, as here, the GMC has itself first brought an appeal, the PSA may advance its case on that appeal on grounds that it might otherwise have proceeded with had the GMC not appealed. The GMC and, in this case, Dr Grajn have the same opportunities to respond had the PSA referred the case to the court (s.40B(4) and (5) of the 1983 Act; Jagjivan v(1) GMC

(2) PSA

[2017] EWHC 1247 (Admin)

(“Jagjivan”);

[2017] 1 WLR 4438

at [38]).

[79]The Court may allow an appeal where the decision is wrong or there has been a serious procedural or other irregularity (Jagjivan at [40]). One type of serious procedural irregularity is under-prosecution (PSA v GMC & Battah

[2022] EWHC 2075 (Admin)

(“Battah”) at [45]).

[80]The question in a case of under-prosecution is whether consideration of the omitted allegation “might have made a significant difference to the Panel’s conclusions on misconduct and fitness to practise, or led them to impose a more severe sanction than they did” (Battah at [48] citing PSA v(1) Health and Care Professionals Council

(2) Doree

[2017] EWCA (Civ) 319

at [58], Lindblom J). In Battah a “failure to highlight” that the regulatory breaches alleged had also been “knowing and deliberate” amounted to under-prosecution ([80]).

GMC’s grounds of appeal

[81]The GMC appeals on the grounds that the MPT’s decision is insufficient to protect the public in that:a. Ground 1: the MPT failed to fulfil the basic duty of assessing Dr Grajn’s fitness to practice in relation to both elements of the allegation made against him, and found proved.

b. Ground 2: the MPT failed to apply the Sanctions Guidance properly to Dr Grajn’s case.

c. Ground 3: as a result of these failures identified in Grounds 1 and 2, the MPT failed to provide adequate reasons for its decision.

[82]The relief sought by the GMC is(a) to allow its appeal;

(b) to quash the MPT’s determination on impairment and sanction;

(d) either substitute the sanction of erasure or remit the matter to the MPT to re-determine sanction in light of the Court’s findings and the Guidance.

The PSA’s grounds of appeal

[83]The PSA “strongly supports” the GMC’s appeal against the MPT’s determinations against Dr Grajn. The PSA also advances further grounds of appeal:a. Ground 1: the GMC wrongly failed to allege against Dr Grajn, after paragraph 2 of the charge laid on 2 January 2025 (“the charge”), that: “Your failure to disclose the determination to the GMC and/or your employer was:

(i) dishonest;

(ii) knowing and deliberate;

(iii) reckless; or

(iv) lacking in integrity.”

b. Ground 2: the GMC wrongly failed to allege in the charge that Dr Grajn had failed to disclose the proceedings before the Board to his employer when asked in 2019 and 2023 whether he was subject to fitness to practise proceedings, and that his failure was dishonest.

c. Ground 3: the MPT wrongly decided on 18 September 2025 not to postpone the hearing of the charge to allow the GMC to investigate the allegations in Ground 2 and, if appropriate, hear them together with the allegations in the charge.

d. Ground 4: the MPT wrongly failed at the hearing of the charge to exercise its power to amend the charges to include the allegations in Grounds 1 and/or Grounds 1 and 2 above.

[84]The PSA is of the view that the imposition of a period of 12 months’ suspension of Dr Grajn, with a review, is insufficient for the protection of the public.

[85]The relief sought by the PSA is for the Court to allow the appeal and, if the Court does not grant the GMC the relief it seeks, to:(a) quash the MPT’s decisions;

(b) direct the GMC to redraft the allegations against the Registrant;

(d) order the GMC and/or Dr Grajn to pay the PSA’s costs.

[86]The GMC’s response to the PSA’s grounds of appeal is that:a. The GMC does not oppose Ground 1.

b. The GMC accepts that a full consideration of Dr Grajn’s misconduct should include consideration of additional allegations sent to Dr Grajn under cover of a letter dated 24 March 2026. The GMC does not accept that it is responsible for any under prosecution in respect of these matters.

c. The GMC maintains that Ground 3 does not add anything material to grounds

(1) and

(2) of the PSA’s appeal.

d. The GMC does not accept that it would have been appropriate for the MPT to have amended the charge at the hearing to include an allegation of dishonesty.

[87]I should also mention that, in advance of the hearing, Counsel for the GMC and the PSA provided the Court with a document entitled “proposed timetable”. That note explained at the outset that “owing to the “three-handed” nature of the proceedings, there is perhaps no perfectly logical order in which to address the issues… If the GMC’s appeal succeeds and the Court decides not to erase Dr Grajn and/or if the PSA’s appeal succeeds on any of its grounds, the likely outcome is that the original allegation and the additional allegations should be remitted to a freshly-constituted MPT”.

[88]Before turning to the grounds of appeal of the GMC and the PSA it is necessary to say more about the factual background to these proceedings before the MPT as, without this, it is not possible to understand the PSA’s further grounds of appeal. It was on this basis that I allowed these documents to be included in the Appeal Bundle at the hearing, which Dr Grajn had objected to in advance of the hearing.

Further procedural background

[89]On 21 February 2024 the GMC became aware of the Board’s determination dated 13 September 2023. The GMC did so from a press article, which was referred to them by the Royal Free Hospital (paragraph 8; page 3 of the MPT’s determinations).

[90]On 30 May 2024 the GMC was aware that:a. Dr Grajn was made aware of the investigation for serious misconduct by the Australian Health Practitioner Regulation Agency on or around 19 June 2018.

b. Dr Grajn had failed to inform the Royal Free Hospital

(i) about the Australian investigation prior to commencing his post there on 17 July 2020, or

(ii) about the Board’s determination on 13 September 2023 during his employment.

c. Dr Grajn had failed to included information about the Australian investigation during his appraisals at the Royal Free Hospital on 20 December 2021 and 17 January 2023.

d. Dr Grajn failed to include information about the Board’s determination on 13 September 2023 during his appraisal at the Royal Free Hospital on 3 February 2024.

[91]On or about 2 January 2025 the GMC referred to the MPT the allegation which came before the MPT in October 2025. This is the allegation set out at paragraph 10 above.

[92]On 3 April 2025 a senior legal adviser at the GMC reviewed the GMC’s case against Dr Grajn and how it had been charged. The advice concludes with the heading “issues and next steps” and says this: “Essentially, it appears that the original R8 decision has failed to adequately consider the application forms completed by Dr G from London Trust which we had available pre-referral. It appears the CE’s must have only had in mind the absence of any obligation to inform the London Trust of the investigation in GMP, rather than Dr G being asked a specific question and, it seems knowingly, providing inaccurate information on several occasions … I am concerned however that we cannot simply leave this as is. I am of the view that there is a significant difference in the severity of this case between just proceeding with what was referred at R8 and the addition of the dishonesty allegations to hearing. There is a real risk of under-charging the case. The CE’s in my view may well have made an error in their approach to this allegation of dishonesty and as such I think we need to seek a R12 review of that R8 decision. This would be based on material error (failure to have regard to the application forms completed by Dr G with the London Trust and as such adequately consider all relevant information re a potential dishonesty charge) … I note we have a listing for October, and so if R12 get a move on we should be OK with this…”.

[93]On 23 July 2025 that the Assistant Registrar issued a decision under rule 12(2) of the 2004 Rules in relation to Dr Grajn and concluded that the case examiner’s decision in this case may be materially flawed and a review of the issues would commence under Rule 12(5).

[94]On 4 September 2025 the Assistant Register decided, under Rule 12(6), to refer further allegations not put to Dr Grajn, and not considered by the Case Examiner at an earlier stage, for “onward consideration by the Case Examiners under Rule 8”. The background to this decision dated 4 September 2025 explains that:

“In summary, the Rule 12 request relates to concerns about the doctor’s failure to inform prospective employers of an overseas open investigation at the time. To be clear, these are separate, albeit related concerns to the allegations already referred to Tribunal by the GMC. The concerns considered within this Rule 12 decision, were not put to the doctor at the Rule 7 stage of the proceedings and therefore the Case Examiners did not consider the same.”

[95]On 26 August 2025 Dr Grajn was informed that the hearing before the MPT would commence on 6 October 2025. On 12 September 2025 the GMC applied to adjourn the hearing until December 2025 on the basis that additional allegations against Dr Grajn were to be investigated. The application was determined by a case manager at the MPT who concluded that the grounds for postponement did not outweigh the factors in favour of allowing the hearing to proceed as scheduled. In relation to the GMC’s submissions she said, amongst other things, that: “While I note that the GMC has made submissions regarding the links between the concerns and the benefits of hearing matters together, I do not attach any weight to this given that the concerns are pre-referral and the MPTS does not have jurisdiction of them”.

[96]The further allegations were eventually sent to Dr Grajn to comment on under rule 7 of the 2004 Rules in the GMC’s letter dated 24 March 2026. The allegations have since been up-dated and I understand are now in these terms:

“That being registered under the Medical Act 1983 (as amended): 1. Between 19 March 2019 and 17 November 2023 you were subject to an investigation by the Medical Board of Australia, which resulted in a Tribunal hearing and determination by the Queensland Civil and Administrative Tribunal (‘the Investigation’) and: a. on or around 6 October 2019, you submitted an application form to the Royal Free NHS Foundation Trust (‘London Trust’) for a post as a Senior Clinical Fellow in HPB & Liver Transplant Surgery and you answered ‘No’ to the question(s): i. ‘Are you currently subject to a fitness to practise investigation and/or proceedings of any nature by a regulatory or licensing body which may have a bearing on your suitability for the position you are applying for? This may include any fitness to practise investigation and/or proceedings of any nature that are being undertaken by a regulatory or licensing body in any other country.’; ii. ‘Are you currently subject to a fitness to practice investigation and/or proceedings by a regulatory or licensing body in the United Kingdom, or in any other country?’; which was untrue; b. on or around 2 March 2023, you submitted an application to the London Trust for a post as a Locum Consultant Renal Transplant Surgeon and you answered ‘No’ to the question(s): i. ‘Are you currently subject to a fitness to practise investigation and/or proceedings of any nature by a regulatory or licensing body which may have a bearing on your suitability for the position you are applying for? This may include any fitness to practise investigation and/or proceedings of any nature that are being undertaken by a regulatory or licensing body in any other country.’; ii. ‘Are you currently subject to a fitness to practice investigation and/or proceedings by a regulatory or licensing body in the United Kingdom, or in any other country?’; which was untrue. 2. You knew that the answer(s) which you gave as set out in paragraph(s) 1a and/or 1b were untrue, in that you had been subject to the Investigation. 3. Your conduct as described at paragraph(s) 1a and/or 1b was dishonest by reason of paragraph 2. And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct.” a. on or around 6 October 2019, you submitted an application form to the Royal Free NHS Foundation Trust (‘London Trust’) for a post as a Senior Clinical Fellow in HPB & Liver Transplant Surgery and you answered ‘No’ to the question(s): i. ‘Are you currently subject to a fitness to practise investigation and/or proceedings of any nature by a regulatory or licensing body which may have a bearing on your suitability for the position you are applying for? This may include any fitness to practise investigation and/or proceedings of any nature that are being undertaken by a regulatory or licensing body in any other country.’; ii. ‘Are you currently subject to a fitness to practice investigation and/or proceedings by a regulatory or licensing body in the United Kingdom, or in any other country?’; which was untrue; b. on or around 2 March 2023, you submitted an application to the London Trust for a post as a Locum Consultant Renal Transplant Surgeon and you answered ‘No’ to the question(s): i. ‘Are you currently subject to a fitness to practise investigation and/or proceedings of any nature by a regulatory or licensing body which may have a bearing on your suitability for the position you are applying for? This may include any fitness to practise investigation and/or proceedings of any nature that are being undertaken by a regulatory or licensing body in any other country.’; ii. ‘Are you currently subject to a fitness to practice investigation and/or proceedings by a regulatory or licensing body in the United Kingdom, or in any other country?’; which was untrue. 2. You knew that the answer(s) which you gave as set out in paragraph(s) 1a and/or 1b were untrue, in that you had been subject to the Investigation. 3. Your conduct as described at paragraph(s) 1a and/or 1b was dishonest by reason of paragraph 2. And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct.”

[97]I understand that Dr Grajn has until 27 May 2026 to comment on these additional allegations before the Case Examiners determine whether they should be referred to an MPT.

The parties’ submissions

[98]Mr Hare KC for the GMC made the following submissions in support of his grounds of appeal. First, the GMC were not inviting the appeal court to substitute any findings of fact made by the MPT. Rather, the MPT had failed to address important matters, such as the QCAT decision dated 13 September 2023, in relation to impairment and sanction. Second, the seriousness of Dr Grajn’s misconduct in Australia has already been determined by the QCAT decision, and QCAT’s findings of fact contained in the decision dated 17 November 2023 are binding on the MPT by reason of rule 34(4) of the 2004 Rules. Third, whilst dishonesty was not alleged by the GMC, a lack of integrity was found by the MPT at the end of its determination on impairment (paragraph 49; page 26 of the determinations). Fourth, there is scattered reference to the “overseas” determination (paragraphs 1, 3, 13, 38 and 49; pages 16, 18, 24 and 25 of the determinations) but the MPT failed to give any consideration of the allegations at 1(a) and (b), and their seriousness, which the MPT had found proved. Fifth, it is very hard to see how any person confronted with Dr Grajn’s behaviour in Australia, coupled with his lack of insight, could not find Dr Grajn impaired in relation to it.

[99]Mr Hare KC submits that, in relation to the consideration of sanctions, the MPT failed to consider critical parts of the case, namely allegations 1(a) and (b), which it had found proved. The MPT considered the second most serious sanction because of Dr Grajn’s failure to disclose the QCAT decision but, if it had taken into account all the allegations it found proved, the decision on sanction would have had a very different outcome. The MPT failed to address anywhere in its determination of sanction the findings of misconduct against Dr Grajn by QCAT. In addition to that, the MPT failed to apply the Sanctions Guidance correctly and, for example, quoted parts of the Sanctions Guidance which were irrelevant to Dr Grajn’s case (eg paragraph 93 and 97(g) of the Sanctions Guidance). On top of that, this was a case where the MPT should have grappled with erasure. The Tribunal’s determination that erasure was a disproportionate sanction was generalised assertion with inadequate reasons. The MPT should have addressed the facts and seriousness of this case, together with the factors identified in paragraph 109 of the Sanctions Guidance, in order to explain why it had determined that erasure was disproportionate.

[100]In support of their grounds of appeal, Ms Morris KC for the PSA submits that the issue why Dr Grajn failed to notify his employer, namely the Royal Free Hospital, and/or the GMC of the decision of QCAT, and his state of mind when he decided not to notify them, is of real significance to the assessment of fitness to practice and any consequent decision as to sanction (PSA v Wood & others

[2019] EWHC 2819 (Admin)

at [56]). If Dr Grajn dishonestly, knowingly and deliberately, recklessly or without integrity sought to avoid the effects of professional disciplinary action taken against him by not notifying those whom he was required to notify, then his misconduct in failing to notify is likely to have been more serious. Accordingly, the PSA submit that Dr Grajn’s state of mind should have been fully addressed by the MPT. However, for the MPT to have addressed Dr Grajn’s state of mind, it should have been included by the GMC explicitly with the allegations against Dr Grajn. The PSA submits that the failure by the GMC to include such an allegation against Dr Grajn contributed to the MPT’s inadequate consideration of the issues in this case and was serious and, if the GMC had advanced such an allegation, the MPT may well have imposed a different outcome on Dr Grajn.

[101]The PSA’s next point on under-charging is that the GMC wrongly failed to allege in the charge that Dr Grajn had failed to disclose the proceedings before the Board to the Royal Free Hospital when asked about fitness to practise proceedings in 2019 and 2023, and his failure to do so was dishonest. These allegations have now been put by the GMC to Dr Grajn in the GMC’s letter dated 24 March 2026. The PSA submit that the MPT’s decision of 18 September 2025 refusing to allow these allegations to be determined at the same time as the original charge against Dr Grajn was wrong, as they form “a pattern of misconduct over time” and that case management decision of the MPT is a decision which can be appealed to this court. Finally, the PSA submit that the MPT had power to, and should have, amended the charge against Dr Grajn of its own motion to “ensure that it properly considered [Dr Grajn’s] state of mind”.

[102]Dr Grajn made very brief submissions in response to the GMC and the PSA’s grounds of appeal. He made it clear that the PSA should not, in his submission, be allowed to repair any defects or errors in the proceedings before the MPT by the GMC and it was wrong that the PSA wanted to have him punished a “second time”. Further, in his oral submissions Dr Grajn argued that his relationship with a former patient was not misconduct; that that former patient had died after he had left Australia; and the Board had been influenced by “emotionally charged testimony” from next of kin and there had been “fabrication”. He said he was not minimising his conduct. Rather, the GMC was presenting what had happened in the wrong context and had “inflated” these matters. Dr Grajn’s main argument was that his appeal should succeed for the reasons he identified (which I have determined earlier in this judgment).

Discussion

[103]The documents I have been taken to during the course of the hearing show that the way the GMC has prosecuted this case against Dr Grajn is, to say the least, unfortunate. The allegations the GMC and the PSA now wish to advance against Dr Grajn concern dishonesty over a period of time and are of the utmost seriousness. This is because they concern separate allegations of dishonesty not only in 2023, but also in 2019. These are allegations which, in many ways, arise out of many of the same facts as were before the MPT. There were, of course, no allegations that Dr Grajn was dishonest before the MPT. The criticisms the GMC now make of the MPT’s determinations are, in my view, not unconnected to the way it presented its case before the MPT.

[104]I listened to all that Dr Grajn had to say in answer to the GMC and PSA’s appeals and, having dismissed his appeal, there was nothing of substance he was able to way in answer to the arguments now advanced by the GMC and the PSA.

[105]I agree with the GMC that the MPT’s approach to impairment and sanction was wrong in the sense that they failed to take properly into account the allegation proved at 1(a) and (b), namely the determination of professional misconduct by QCAT. Mr Hare KC sought to persuade me that, if the appeal was allowed on that first ground, then I should determine the appropriate sanction, although he appreciated that that was, to use his words, a “big ask” in the present circumstances.

[106]I am quite clear that is not the appropriate way forward in this case. This is because the fundamental problem faced by the GMC is that this is a case which it has under-prosecuted, and Dr Grajn should have a full opportunity to respond to all the allegations. On 30 May 2024 the GMC was aware that Dr Grajn had known since on or about 19 June 2018 that he was subject to an investigation for serious misconduct by the Australian Health Practitioner Regulation Agency; that Dr Grajn had failed, when asked, to inform the Royal Free Hospital about the investigation in Australia before he started work there in July 2020; and Dr Grajn had failed to inform the Royal Free Hospital and the GMC about QCAT’s decision dated 13 September 2023. Dr Grajn had, therefore, been aware of the investigation in relation to his professional conduct for over five years before the QCAT determination on 13 September 2023 and the GMC were aware of this on 30 May 2024, which was more than 16 months before the MPT hearing in October 2025.

[107]In these circumstances, I agree with the PSA that Dr Grajn’s state of mind when he decided not to notify the Royal Free Hospital and/or the GMC of QCAT’s determination dated 13 September 2023 is of real significance in relation to both the assessment of fitness to practise and of any consequent decision as to sanction. This is because if, for example, Dr Grajn acted dishonestly, then his misconduct in failing to notify is likely to be more serious. In addition to that, I agree with the PSA that the GMC wrongly failed to allege in the charge that Dr Grajn had failed to disclose the proceedings in Australia to his employer in the UK when asked, in 2019 and 2023, coupled with an allegation that that failure was dishonest. This failure, which was some four years’ earlier than the allegation which was before the MPT, is also of real significance for the assessment of fitness to practise and any consequent decision as to sanction. This is because it relates to alleged conduct by Dr Grajn which is not only said to be dishonest, but also have taken place at a much earlier stage in time. This, therefore, is a case where I have reached the very clear view that there has been a serious procedural irregularity in relation to the GMC’s prosecution of this case against Dr Grajn. I therefore allow the PSA’s appeal on grounds 1 and 2.

[108]In these circumstances, there is no need for me to determine grounds 2 and 3 of the GMC’s appeal. Further, there is no need for me to determine grounds 3 and 4 of the PSA’s appeal and, in particular, whether a case management decision by the MPT is a decision subject to the appellate jurisdiction of this court. However, having read the MPT’s decision of 18 September 2025, it is difficult to criticise the MPT for deciding what it did on that occasion, given the conduct of the proceedings by the GMC, and the way matters were presented to it. Likewise, as to ground 4, I would be reluctant to make any criticism of the MPT for not making any amendment of the charge of its own motion, given the way that the GMC had chosen to prosecute the case, and because the GMC were represented by counsel throughout the hearing.

[109]Finally, I should add this. Mindful that Dr Grajn is acting in person I asked Ms Morris KC what points, if any, could be made in his favour in this situation. She submitted that, first and foremost, the court should be concerned about the protection of the public. She recognised that the present situation was unfortunate and said that Dr Grajn’s recourse was in relation to costs against the GMC. However, as to that, Ms Morris KC recognised that Dr Grajn had been acting in person throughout these proceedings. Therefore a costs sanction against the GMC is unlikely to be of much assistance to Dr Grajn in the present circumstances. I, of course, have in mind that the protection of the public is critical, but on the information I have seen (and I appreciate it may not be complete) it is hard not be concerned about the course of the proceedings in this case, and that a further Tribunal hearing will now be necessary.

Outcome

[110]For the reasons I have identified, the GMC’s appeal is allowed on ground 1 and the PSA’s appeal is allowed on grounds 1 and 2. The consequence of this is that all determinations of the MPT are quashed and the matter will need to be remitted to a different constituted Tribunal for a fresh hearing.

[111]I will hear from the parties as to the appropriate directions, but the matter will need to be dealt with by all parties and the Tribunal with as expeditiously as possible. __________________

Order

The sanction is punitive and disproportionate, unsupported by evidence, and imposed solely to “send a message”. The Immediate Order repeats the same error without balancing under Sanctions Guidance paragraphs 172 to 178. e. Ground 5 – Reasons and fairness: The Tribunal failed to engage with Dr Grajn’s statutory submissions or give intelligible reasons.