Case Comment: Hyder v General Medical Council [2024] EWHC 2945 (Admin)

BACKGROUND

This case concerned Dr Syed Farhan Hyder, whose name was ordered to be erased from the Medical Register by the Medical Practitioners Tribunal in December 2023. The Tribunal’s decision followed findings of dishonesty, where Dr Hyder falsely claimed to have achieved qualifications in the Membership of the Royal College of Physicians (MRCP) examinations. These misrepresentations were made orally and in writing to locum agencies between 2014 and 2017,

The allegations were grave: that Dr Hyder knowingly and dishonestly provided false information regarding his MRCP status to secure work. Although there was no evidence that he obtained employment or higher pay as a result, the dishonesty persisted over several years. Despite accepting the Tribunal’s findings of fact and its conclusion that his fitness to practise was impaired, Dr. Hyder appealed the sanction of erasure, arguing it was excessive and disproportionate.

DECISION

The appeal, heard before Mr Justice Eyre in the High Court, was dismissed on 19 November 2024. The court upheld the Tribunal’s decision, finding that erasure was appropriate and necessary to protect the public, maintain confidence in the medical profession, and uphold professional standards. 

Dr. Hyder argued that the cumulative effect of the suspensions he had already faced, totalling around 15 months, was sufficient to mark the gravity of his conduct. While the court recognised the severity of depriving a competent doctor of their livelihood, it emphasised that the overarching purpose of the disciplinary process is the protection of the public rather than punishment.

Key considerations included:

• Persistence of dishonesty: Dr Hyder’s false statements about his MRCP qualifications spanned over three years and were repeated on multiple occasions.

• Lack of insight and remediation: The Tribunal found that while Dr Hyder demonstrated a theoretical understanding of honesty and integrity, he failed to show sufficient insight into his own misconduct. He did not adequately explain his motivations for acting dishonestly or provide evidence of meaningful remediation.

• Risk of repetition: In the absence of demonstrated insight or practical evidence of change, the Tribunal and the court concluded there was a significant risk of similar behaviour recurring.

Application of the Guidance
The Tribunal’s application of the General Medical Council’s Sanctions Guidance was another key point of analysis. On appeal, it was argued that the Tribunal had misunderstood and misapplied the Guidance by relying too heavily on the persistence of the dishonesty to justify erasure, without giving sufficient weight to mitigating factors such as the absence of financial gain, the lack of further misconduct since 2017, and the appellant’s reflections on honesty. The appellant also contended that the Tribunal misinterpreted paragraph 109(h) of the Guidance, which addresses dishonesty that is “persistent and/or covered up,” arguing that the absence of any cover-up should have been a significant factor against erasure.

The High Court rejected these arguments, affirming that the Tribunal had correctly applied the Guidance. It emphasised that while the Guidance is not binding, it provides an authoritative steer for tribunals and was appropriately followed in this case. The court agreed that the persistent nature of the dishonesty, spanning over three years, met the threshold for erasure under paragraph 109(h), even in the absence of concealment. It also noted that the Tribunal had adequately considered mitigating factors but found them insufficient to outweigh the seriousness of the misconduct and the ongoing risk posed by the appellant’s limited insight and lack of meaningful remediation.

Assessment of Evidence: Tribunal vs Appeal Court
The judgment also illuminated the nuanced roles of the Tribunal and the appeal court in assessing evidence. On appeal, it was argued that the Tribunal’s assessment of insight was flawed and overly reliant on subjective impressions of Dr Hyder’s demeanour during his oral evidence. The appellant contended that the appeal court, equipped with the full transcript, was equally capable of evaluating the evidence and reaching its own conclusions. Additionally, it was submitted that the Tribunal placed undue weight on perceived inconsistencies in the appellant’s oral testimony, which may have been influenced by his medical condition and medication.

The High Court rejected these arguments, affirming the principle that tribunals are better placed to assess live evidence, particularly on matters such as credibility and insight. It emphasised that while the appeal court has full jurisdiction to substitute its own decision, significant deference should be given to the Tribunal’s findings where they are based on direct observation of the evidence. The High Court noted that the transcript supported the Tribunal’s conclusions, particularly its characterisation of the appellant’s evidence as inconsistent and evasive. Furthermore, the appellant had not provided medical evidence to substantiate the claim that his testimony was affected by his health or medication, leaving the Tribunal’s assessment unchallenged.

COMMENT 

This judgment offers some lessons for legal professionals advising clients in fitness-to-practise cases, particularly where dishonesty is involved. It highlights several key considerations:

Insight is important: Tribunals and courts require more than theoretical reflections on the importance of honesty. As demonstrated in this case, while it is not strictly necessary for a registrant to explain the motivations behind their dishonesty, the absence of such an explanation makes it significantly harder to demonstrate the practical insight required to avoid the risk of repetition. Insight must extend beyond general principles to address the specific circumstances of the misconduct, identifying its root causes and showing how behaviour has changed. Without this, tribunals are likely to conclude that the risk of repetition remains.

Public confidence outweighs individual hardship: Even though the suspensions already faced by Dr Hyder were argued to be punitive enough, the court reaffirmed that the overarching purpose of disciplinary sanctions is the protection of the public and the maintenance of professional standards—not punishment. Even where dishonesty does not directly harm patients or result in financial gain, it can undermine public trust in the profession. This reflects the priority given to upholding public trust in regulated professions, especially in cases of dishonesty relating to professional qualifications.

Public confidence outweighs individual hardship: Even where dishonesty does not directly harm patients or result in financial gain, it can undermine public trust in the profession. This decision reinforces the principle that maintaining public confidence and professional standards is central to regulatory sanctions.

Assessment of evidence requires strategic preparation: The High Court’s deference to the Tribunal’s findings on insight and credibility reinforces the importance of presenting credible, consistent, and reflective evidence at the Tribunal stage. As seen here, the Tribunal’s live observation of the registrant’s demeanour carried significant weight.

For those representing clients in future cases, this judgment highlights the need to provide comprehensive evidence of insight, reflective practice, and remediation. Failure to do so may lead to the harshest sanctions, even where other mitigating factors exist. This case is a reminder of the high standards expected within regulated professions and the uncompromising stance taken against dishonesty.