Court of Appeal clarifies how tribunals should apply sanctions guidance in fitness to practise cases

The Court of Appeal’s judgment in General Medical Council v Gilbert & Anor [2026] EWCA Civ 53 provides important clarification for doctors on how the GMC’s Sanctions Guidance should be applied in fitness to practise proceedings, particularly where allegations involve non‑clinical misconduct. Although the case concerned the Medical Practitioners Tribunal Service (MPTS), the Court made clear that the underlying principles apply across the UK’s wider healthcare regulatory landscape.

Background to the case

Dr James Gilbert, a consultant surgeon at Oxford University Hospitals NHS Foundation Trust, faced a series of allegations spanning more than a decade, including sexually motivated comments, unwanted physical contact towards junior female colleagues, and racist remarks made in clinical settings. A 19‑day MPTS hearing in 2024 found most allegations proved and determined that his fitness to practise was impaired. The Tribunal imposed an eight‑month suspension without review, concluding that although the misconduct was serious, it was not fundamentally incompatible with continued registration and that Dr Gilbert had demonstrated insight and remediation.

The GMC and the Professional Standards Authority appealed, arguing that only erasure could maintain public confidence. The High Court upheld the suspension—extending it to 12 months—but rejected erasure. Both regulators then appealed again. On 6 February 2026, the Court of Appeal dismissed those appeals, confirming that the MPTS had applied the correct legal framework and that its sanction was within the reasonable range of outcomes.

How tribunals should approach the Sanctions Guidance

The Court confirmed that the Sanctions Guidance is a framework for structured reasoning, not a formula that mechanically dictates outcomes. It rejected the argument that the 2025 Guidance—with its low, medium and high‑risk bandings—requires tribunals to escalate sanctions in a linear or automatic way.

Instead, panels must make a holistic evaluative judgment, considering:

• the seriousness and context of the misconduct
• the doctor’s insight and remediation
• the risk of repetition
• the need to maintain public confidence
• proportionality in the regulatory response

This approach is particularly important in cases involving non‑clinical misconduct, where behaviour may be serious but the future risk may be low if the doctor has demonstrated meaningful change.

Key principles reinforced by the Court

The judgment sets out several principles that now guide how tribunals should apply the Sanctions Guidance in fitness to practise cases:

• No “score sheet” approach — Tribunals must avoid treating aggravating factors (such as sexualised behaviour, harassment or racist remarks) as automatically requiring erasure.
• Insight and remediation matter — Even in serious behavioural cases, evidence of genuine learning and change can justify a suspension rather than removal.
• Risk‑based decision‑making — The central question remains whether the doctor poses an ongoing risk to patients or public confidence.
• Tribunal discretion is primary — Appellate courts will intervene only if a decision is wrong, not simply because a regulator considers it too lenient.
• Sanctions are regulatory, not punitive — The purpose is to protect the public, not to punish past behaviour. 

Implications for non‑clinical misconduct cases

The Court’s reasoning is especially relevant for cases involving:

• sexual comments or unwanted physical contact
• bullying or harassment
• discriminatory or racist behaviour
• inappropriate conduct towards colleagues

While such behaviour is always serious, the Court confirmed that non‑clinical misconduct can be remediable. Tribunals are entitled to conclude that suspension is sufficient where:

• the doctor has demonstrated insight
• there is evidence of behavioural change
• the risk of repetition is low
• public confidence can be maintained through a proportionate sanction

This reinforces the principle that fitness to practise outcomes must be tailored to the individual case rather than driven by assumptions about particular categories of misconduct.