The High Court quashes a three-month suspension due to the panel’s reasoning in respect of dishonesty.

Alam v GMC [2025] EWHC 2907 (Admin)

Background

Dr Alam, a partner at a GP practice prepared data for the Quality Outcomes Framework (“QOF”), which measures a variety of activities by GPs including inviting patients for an annual review. Due to staffing shortages, Dr Alam completed QOF data whilst working into the night over the Easter bank holiday weekend of 2018 whilst she was on sick leave. The process involves examining thousands of patient records. She checked if patients had attended appointments recently and might have been invited to a review that had not been recorded. In doing so, Dr Alam made retrospective records of invites to annual reviews.

The GMC alleged that all 28 such entries were made dishonestly and in a state of panic. Dr Alam denied this, and stated that the entries were honestly made, though some of them were made mistakenly.

The Medical Practitioners Tribunal that considered the case (“the panel”) reviewed each entry, and accepted Dr Alam’s explanation that she had honestly recorded that she had verbally invited the patients that she had seen to a review, and that she had honestly retrospectively recorded that two other experienced members of staff had done the same. However, the panel did not accept that Dr Alam had assumed that other staff would have done so in light of an email to her (produced in evidence) saying some clinicians were not following the prompts to invite patients to annual reviews, and those members of staff were unhappy, inexperienced or new. Additionally, the panel did not accept it was credible that as Dr Alam had built the level of trust with those staff members, they had extended the invitation to an annual review. Therefore, the panel considered that she must have made those records dishonestly.

Therefore, the panel had in effect concluded that Dr Alam had acted honestly one minute and then she had acted dishonestly the next minute. In the written decision on facts, the panel did not make any reference to the good character direction they had received or the positive testimonials that were before them.

Dishonesty was found proven in respect of 14 patients. Dr Alam’s fitness to practise was found to be impaired and a three-month suspension was imposed.

Basis of appeal 

Dr Alam appealed the decision under Section 40 of the Medical Act 1983 on the basis that: 

1. the panel failed to review the overall consistency of the findings of honesty and dishonesty, and 
2. the panel had incorrectly reversed the burden of proof in that they found dishonesty from the absence of evidence of honesty. 

The GMC opposed the appeal. 

Outcome of appeal 

In allowing the appeal, His Honour Judge Jarman KC sitting as a judge of the High Court held that: 

1. The panel had not stood back from the minutiae to take an overview of the case given that they accepted many entries had been made honestly. 
2. The terminology used by the panel suggested a reversal of the burden of proof; for example, reference made to giving Dr Alam the benefit of the doubt ‘on this occasion’ when making a finding that dishonesty was not proved in relation to one patient strongly suggested that such benefit was not provided on other occasions. Additionally, this implies that the panel assumed Dr Alam was guilty of dishonesty unless she proved otherwise, which would constitute a reversal of the burden of proof.
3. The panel had not taken into account the evidence of Dr Alam’s good character or that it might make it unlikely that she would have made some entries dishonestly. Here, it was highlighted in the judgment that ‘mistake is more likely than mischief’, meaning that genuine errors are more common than any intentional wrongdoing / deceiving conduct. The High Court quashed the findings of dishonesty and impairment and the decision to suspend Dr Alam.

Capsticks’ view, and how we can help 

This decision highlights the importance of the proper application of the burden of proof when considering the sufficiency of evidence of any alleged dishonesty, the need to clearly signpost evidence which is being relied upon to support an allegation of dishonesty, and the importance of making submissions as to how a panel should deal with good character evidence. Moving forwards, panels need to step back from the detail of a case and adopt an approach which is centred around the bigger picture / overview of a case. 

Capsticks, a leader in the professional discipline domain, draft a wide range of allegations with a large team of advocates who regularly present cases before panels. Capsticks regularly provides training to regulators and/or their panel members on a variety of legal issues. 

This article was co-authored by Jessica Bass, Senior Associate, Barrister and Izzy Darwent, Trainee Solicitor in our Regulatory Team. If you have any queries around what is discussed in this article, and the impact on your organisation, please speak to Jessica Bass or anyone in our regulatory team to find out more about how Capsticks can help.