In Thampi v General Medical Council [2026] EWHC 1036 (Admin), Dr Premila Thampi challenged both the Medical Practitioners Tribunal’s finding of impairment and its decision to impose a sanction of a three-week suspension. The appeal succeeded only in part. The High Court upheld impairment but overturned sanction, giving guidance on the limits of tribunal fact-finding, the status of “exceptional circumstances” in sanctions guidance and the need to assess proportionality by reference to the actual effects of suspension on the doctor concerned.

This insight breaks down the judgment first in relation to the impairment challenge and then in relation to the sanction challenge. It also considers the key takeaways from the case.

Impairment

The Court found that the Medical Practitioners Tribunal (the Tribunal) had erred in finding that Patient A had suffered “psychological harm”. No such allegation had been pleaded, there was no expert evidence adduced to support it and Dr Thampi had not been given a fair opportunity to respond to it. This decision of the Court reiterated the position set out in R (El-Baroudy) v General Medical Council [2013] EWHC 2894 (Admin), which confirms that the Tribunal cannot make causative findings where no such case has been advanced.

Despite this, the Court held that the Tribunal had been entitled to find that the seriousness of Dr Thampi’s failings outweighed the mitigating features of the case, and so the decision of impairment was upheld, with Dr Thampi found to be impaired on grounds of public confidence and maintaining professional standards. Importantly, Dr Thampi was not found impaired on the ground of public protection.

Sanction

The Court reached a different conclusion on sanction, finding that the Tribunal wrongly imposed a three-week suspension. The sanction guidance in place at the time stated that taking no action following a finding of impairment will only be appropriate in “exceptional circumstances”. The Court concluded that the Tribunal was wrong to use the guidance as prescribing a threshold of exceptional circumstances, clarifying that guidance is “not prescriptive but indicative”. The phrase “exceptional circumstances” therefore describes the rarity of such an outcome; it is not a prescriptive rule and has no basis in the Medical Act 1983 or the GMC (Fitness to Practise) Rules 2004.

Since this case came before the Tribunal, the Medical Practitioners Tribunal Service (MPTS) sanction guidance has been updated. In respect of taking no action, it now states that: “Where a doctor’s fitness to practise is impaired, it will usually be necessary for the MPT to restrict the doctor’s registration to achieve public protection. But there may be exceptional circumstances to justify an MPT taking no action. Exceptional circumstances are unusual, special, or uncommon, so such cases are likely to be very rare.”

Taking no action will remain an uncommon decision following a finding of impairment, but it remains available in an appropriate case. The guidance makes specific reference to achieving public protection, and so this judgment may be especially important where impairment is found on public confidence or standards grounds alone. In those circumstances, the finding of impairment itself may be sufficient to meet the public interest without any further sanction.

The Court also found that the Tribunal had failed properly to address the real consequences of suspension. The evidence showed that Dr Thampi’s NHS locum contract required continuous registration and would terminate automatically if she were suspended. Despite this, the Tribunal treated dismissal as a possibility that might somehow be avoided. The Court held that proportionality had been assessed against a hypothetical rather than the actual position, and that the resulting employment consequences would be out of all proportion to Dr Thampi’s failings.

Conclusion

This case raises three particularly important points. First, tribunals cannot make findings of harm or causation that have not been pleaded and fairly put to a registrant. Secondly, “exceptional circumstances” is not a free-standing legal threshold for taking no action after a finding of impairment. Thirdly, proportionality requires careful attention to the direct consequence of the sanction on the registrant; in some cases, the finding of impairment alone may be enough.

Capsticks' view

For practitioners, this case reiterates the importance of clearly pleading and properly evidencing allegations of harm or causation. In respect of sanction, it also raises the need to distinguish between cases in which impairment rests on public confidence or standards alone, and not public protection. In such cases, the public interest may be met by a finding of impairment without the need for sanction. Finally, the Court’s findings in respect of proportionality suggest that panels should consider the direct consequences of any sanction imposed on a registrant and consider whether that sanction remains proportionate in light of those consequences.

How Capsticks can help

Capsticks’ leading specialist professional regulatory team provides training to a number of regulators and assists with guidance or training targeted at case presenters, Panel members or in-house legal teams. If you would like to reach out about the services we offer or discuss an issue raised in this article, please contact Senior Associate Adam Slack to find out more about how Capsticks can help.

This article was co-authored by Trainee Solicitor Lucy Harris.