This article summarises the decisions in recent Professional Standards Authority (PSA) appeals relating to two General Medical Council (GMC) cases: PSA v (1) GMC & (2) Hughes [2026] EWHC 1138 (Admin) and GMC & PSA v Grajn [2026] EWHC 1157 (Admin). Both sexual misconduct cases were heard by the Medical Practitioners Tribunal and resulted in 12-month suspension orders with review.

In Hughes, the PSA argued that erasure was the only sanction reasonably open to the Tribunal. Dr Hughes opposed the appeal, and the GMC adopted a neutral stance. In Grajn, both the PSA and the GMC appealed a 12-month suspension with review on grounds that such a sanction was insufficient to protect the public. Dr Grajn cross-appealed on various grounds. Both appeals and their judgments provide helpful reminders and lessons for those involved in professional regulatory cases.

Hughes

The case against Dr Hughes related to his relationship with a patient (A) he first treated when she was 13 years old. A was vulnerable because of her disabilities. The relationship developed over a number of years and became sexual. After the relationship broke down, A reported the matter to the police. The allegations related to messages sent by Dr Hughes to A, the sexual relationship and A’s vulnerability.

The PSA argued that the Tribunal that had considered the case had erred in either:

• concluding that suspension was a sufficiently serious sanction, by failing to have proper regard to the Sanctions Guidance and giving undue weight to the deterrent effect of suspension, the public interest in keeping Dr Hughes on the register and/or the mitigating factors; or
• failing to find that Dr Hughes had not exploited A’s vulnerability.

Both grounds were unsuccessful and the appeal was dismissed. Mr Justice Murray held that:

1. The Record of Determination revealed no error of fact or approach. It was a difficult case that was factually nuanced and could be distinguished from other cases of sexual misconduct where erasure was required.
2. The Tribunal had paid careful regard to the Sanctions Guidance to the relevant extent.
3. The Tribunal clearly found that A was vulnerable and had that fact firmly in mind.
4. The Tribunal had not given undue weight to the matters relied upon by the PSA.

Grajn

The case against Dr Grajn related to a finding of professional misconduct that had been made against him by the Medical Board of Australia and its imposition of a two-year disqualification and his failure to disclose that determination to the GMC or his employer. This misconduct finding related to a failure by Dr Grajn to maintain appropriate professional boundaries with a patient and/or former patient by engaging in an inappropriate and/or sexual relationship with her.

Dr Grajn’s appeal was heard first and was unsuccessful. His arguments relating to the ability of the GMC to make findings against him based on the Australian decision were rejected, as were his challenges to the merits of the sanction decision.

The GMC’s appeal related to the Tribunal’s decisions on impairment and sanction, and sought substituted findings of impairment and either sanction or remittal for sanction. It argued that the Tribunal had failed to properly assess Dr Grajn’s fitness to practise, apply the Sanctions Guidance and give adequate reasons for its decision.

The PSA supported these grounds and argued that there had been under-prosecution of the elements of dishonesty present in the case, both in the way the allegations were framed and the Tribunal’s failure to take appropriate action. The PSA sought a quashing of the Tribunal’s decisions, an order directing the GMC to redraft the allegations and remittal to a differently constituted Tribunal.

Mrs Justice Tipples described the way in which the GMC had prosecuted the case against Dr Grajn as being “to say the least, unfortunate”. The Judge rejected the GMC’s attempt to persuade her to substitute decisions on the basis of the “fundamental problem” faced by the GMC – that it had under-prosecuted the case and Dr Grajn was entitled to a full opportunity to respond to all the allegations.

To that extent, the PSA’s appeal succeeded. The Judge agreed with the PSA that Dr Grajn’s state of mind when he decided not to notify his employer and/or the GMC of the Australian decision was of real significance in relation to both the assessment of fitness to practise and of any consequent decision as to sanction. The inclusion of a charge relating to an earlier incident of alleged dishonesty would also extend the period over which the dishonesty continued.

The Judge found that there had been a serious procedural irregularity in relation to the GMC’s prosecution of the case, quashed all determinations and remitted the matter to a differently constituted Tribunal for a fresh hearing.

Conclusion

The judgment in Hughes provides a helpful reminder of the limits of the appellate jurisdiction, neatly summarised by Mr Justice Murray in paragraph 106 of his judgment:

“… I bear in mind that this is a review jurisdiction, where the issue is whether the Tribunal reached the wrong conclusion about sanction, notwithstanding the expertise of the Tribunal, its detailed findings of fact having had the benefit of extensive written and oral evidence, and having carried out a multifactorial evaluation, in relation to which this court should show an appropriate degree of deference.”

The judgment in Grajn emphasises the care needed in prosecuting cases of dishonesty, to ensure that all relevant incidents are captured and that dishonesty is charged where indicated by the evidence. This is particularly important where the case relates to a failure to disclose a material matter.

How Capsticks can help

Capsticks’ market-leading professional disciplinary practice acts for a wide range of statutory and non-statutory regulatory bodies. Our team of specialists is experienced at navigating complex evidential issues such as those discussed in this article. To find out more, please contact Regulatory Partner, Ros Foster.