In the case of PSA v GMC relating to Dr David Dighton, the High Court, in allowing the appeal, commented, among other things, voluntary erasure not enough to protect the public.
Professional Standards Authority for Health and Social Care v General Medical Council and another -  EWHC 3122 (Admin)
Dr Dighton was a cardiologist but also maintained a private practice as a General Practitioner. It is important to note that Dr Dighton had undergone no formal GP training, which he regarded as “unnecessary because of his work in general medicine and "the minor nature of his patients' ailments."”
Between 2011 and 2017, on multiple occasions at the patient’s request, Dr Dighton prescribed to Patient A a number of powerful and potentially addictive drugs.
Over the same period, Patient A also obtained multiple prescriptions from her own GP for drugs of the same type. On 23 June 2017, Patient A was diagnosed with (among other things) prescription drug dependency.
Dr Dighton has in the past confirmed in writing that he was aware from the start that Patient A demonstrated the behaviour of an addict.
In 2011, Dr Dighton was issued with a letter of advice from the GMC relating to his prescribing. In 2016, he appeared before the GMC's Investigation Committee and was issued with a warning relating to his prescribing of benzodiazepines.
The proceedings before the MPTS took place in 2019 during which the GMC made numerous allegations of misconduct.
On the basis of the facts which it had found proved, the MPTS determined that Dr Dighton's actions amounted to misconduct.
It went on to consider whether his fitness to practise was currently impaired by reason of misconduct, balancing the various factors which it regarded as weighing for and against impairment.
The MPTS expressed grave concerns in relation to Dr Dighton's poor practice over a six-year period despite an advice letter in 2011 and a warning in 2016.
It described his lack of insight as "intractable" such that "he is unlikely to remediate and there is a material risk of repetition." The combination of lack of insight, unfocused training, lack of any apology and lack of reflective practice meant that the risk of repetition could not be regarded as low.
The MPTS concluded that the his fitness to practise was impaired.
On the final day of the hearing, the MPT considered sanction. It considered oral evidence from Dr Dighton including that he had stopped work as a GP in December 2018 because of a discussion with an adviser from the Care Quality Commission who had impressed upon him that GP work was a speciality and that his experience was limited.
Upon weighing the mitigating and aggravating factors, the MPST decided to impose a suspension order on Dr Dighton giving “decisive weight to the fact that the second respondent had ceased to practise as a GP” and therefore held that his conduct was not fundamentally incompatible with his inclusion on the medical register.
The PSA challenged the sanction on three grounds, that the MPTS:
Prior to the appeal being heard, Dr Dighton agreed to voluntary erasure.
The GMC sought to persuade Farbey J that the appeal served no practical purpose “because the GMC is willing to grant his application for voluntary erasure.” In disagreeing with this argument, Farbey J commented that Dr Dighton “willingness to give up practice as a GP cannot reasonably be regarded as weighing decisively in favour of his suspension and against his erasure.”
She continued by saying: “The statutory regulation of the medical profession is designed to prevent the sort of risks which the second respondent [Dr Dighton] caused to Patient A. The second respondent's resistance to regulatory control is a further facet of his lack of insight that means that he cannot be trusted to practice as a doctor again. That may only be reliably achieved by erasure.”
Farbey J removed Dr Dighton from the Register instead of remitting the case back to the MPTS.
As with many of these cases, the outcome turned on the facts. However, in all these cases there are lessons to learnt when reflecting on these facts.
In this case a number of things can be taken away by healthcare professionals:
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