Dr Premila Thampi v The General Medical Council

Dr Premila Thampi appeals, under s. 40 of the Medical Act 1983 (“the Act”), against two decisions of a panel of the Medical Practitioners Tribunal (“the MPT”): its finding that her fitness to practise was impaired and the suspension of her registration for three weeks.

There are five grounds of appeal: the first two relate to the question of impairment and the latter three concern sanction. It is said that the MPT:

In 1987, Dr Thampi qualified at the University of Madras. As a junior doctor practising in India, she worked in obstetrics, gynaecology and paediatrics and was later awarded a post-graduate diploma in obstetrics and gynaecology. In May 1991, Dr Thampi came to the United Kingdom. In 1996, she became a Member of the Royal College of Obstetricians and Gynaecologists and was granted full registration by the General Medical Council (“the GMC”). In 2007, she was entered on the specialist register for obstetrics and gynaecology.

In October 2016, Dr Thampi was practising as a Consultant in Obstetrics and Gynaecology at the Milton Keynes University Hospital NHS Foundation Trust (“the Trust”). On 23 October 2016 at 7.10 p.m., Patient A was admitted to Milton Keynes University Hospital. She was at 41 weeks and 3 days’ gestation; her waters had broken and she was experiencing irregular contractions. It was her first pregnancy.

Dr Thampi first examined Patient A on the morning of 24 October 2016 at about 8.30 a.m. The progress of the labour was noted and a plan prepared to continue monitoring her. Patient A was later examined again by Dr Thampi and the midwife. At about 4.15 p.m., the midwife told Dr Thampi that Patient A had a raised temperature and a heightened pulse. Dr Thampi advised that Patient A should continue to be administered with intravenous fluids and antibiotics because of the risk of infection and the fact that contractions had been felt for more than a day. A plan was made for Dr Thampi to examine Patient A at 6.30 p.m.

The contemporaneous medical notes record that at 6.26 p.m. instrumental delivery was discussed because of the “sub-optimal” cardiotographic (“CTG”) reading. This stage in Patient A’s labour was fundamental to the later case against Dr Thampi because the principal issue before the MPT was whether at this time Patient A had consented or objected to the use of a Kiwi vacuum device (also described as a “Kiwi Ventouse” or simply as a “Kiwi”) and/or forceps. The notes recorded that consent to the use of the vacuum device was given at 6.26 p.m. and it was applied at 6.55 p.m. Forceps were later used and Patient A’s baby was born on 24 October 2016 at 7.22 p.m.

Dr Thampi’s post-delivery note, timed at 8 a.m. on 25 October 2016, stated that:

Mother and baby were discharged from hospital on 27 October 2016.

Some 18 months after the birth, on 18 July 2018, Patient A wrote a letter of complaint to the Trust. The letter is detailed but in summary Patient A said that Dr Thampi had given her insufficient information about her care. In particular, it was said that Dr Thampi had used Patient A’s fear and the fear of harm to her unborn baby to coerce consent for an instrumental delivery.

The complaint was considered and, following an internal disciplinary process, Dr Thampi received a first written warning.

Following the disciplinary process, on 14 February 2020, the Trust referred Dr Thampi to the GMC. The referral concerned Dr Thampi’s instrumental delivery of Patient A’s baby using a Kiwi vacuum device and forceps. It was said that Dr Thampi used the vacuum device inappropriately and thereafter she should have carried out a caesarean section. It was also said that Dr Thampi had been unprofessional towards and dismissive of Patient A who had made it clear that she did not want a forceps delivery but felt under pressure to do so. In the circumstances, it was alleged that Dr Thampi had not carried out a proper consent process.

On 30 May 2022, the GMC wrote to Dr Thampi to inform her of the allegations to which she responded on 13 January 2023. On 8 March 2023, the GMC notified Dr Thampi that her case had been referred to the MPT. Thereafter, the preparation of the case by the GMC took some time until the first stage of the proceedings before the MPT (namely, fact-finding) was heard in September and October 2024, just shy of eight years after Patient A’s baby was delivered.

The Allegation contained the charges against Dr Thampi. By the time of the determination on the facts, it was alleged that:

Following the hearing in September and October 2024, the determination on the facts was handed down on 2 May 2025. The MPT found that:

On 8 May 2025, the MPT made its determination on impairment. The MPT reminded itself of the allegations that it had found to be proved and considered that the relevant issues were Dr Thampi’s failures to obtain informed consent and to communicate appropriately with Patient A: para. 64.

At para. 65, the MPT said that it had also had regard to the “impact on Patient A from the conduct it had found proved.” The determination summarised Patient A’s evidence to the effect that the experience of labour “still rules my life”; she had undergone counselling; she had sought to avoid new relationships for fear of falling pregnant again; she had decided against a career in midwifery and the trauma had delayed her making a formal complaint for 18 months after her baby’s birth.

The MPT considered that the proven allegations were “key ingredients to obtaining informed consent” but accepted that there were no findings of clinical negligence and the case was an isolated incident affecting one patient. That said, the MPT also concluded that the twin failures to obtain informed consent and to communicate appropriately were “serious matters, both individually and cumulatively”: para. 66.

The MPT directed itself to the relevant parts of Good Medical Practice (“GMP”) and the GMC’s guidance entitled “Consent: patients and doctors making decisions together” (2008) (“the 2008 Consent Guidance”) and concluded that Dr Thampi’s actions fell short of what would be proper in all the circumstances.

Having found that the proved facts amounted to misconduct, the MPT then considered whether Dr Thampi’s fitness to practise was currently impaired by reason of her misconduct. Although the panel recognised the absence of clinical negligence and the isolated and confined nature of the incident, nonetheless it considered Dr Thampi’s failings to be serious. In para. 77 the panel identified those factors in Dr Thampi’s favour but went on to say that:

For those reasons, the MPT considered that each limb of the Grant test (summarised at para. 37 below) had been satisfied: where a doctor’s fitness to practise is impaired if she has in the past acted and/or is liable in the future to act so as to put the patient or patients at unwarranted risk of harm; and/or has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession.

The MPT found that Dr Thampi had insight into her actions and failures; she had carried out sufficient remediation work and that there was a low risk of repetition: para. 87. In such circumstances, the MPT considered whether the seriousness of Dr Thampi’s actions and failures justified a finding of current impairment of her fitness to practise in the wider public interest. At paras. 89-91 of the determination, the MPT said that:

The MPT concluded that a finding of impairment was necessary to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of the profession. Given its finding that Patient A had suffered “psychological harm” as a result of her experience of labour, notably the panel did not conclude that impairment was necessary to protect the health, safety and wellbeing of patients.

On 12 June 2025, the MPT made its determination on sanction. In dealing with various preliminary points, the determination dealt with a submission made by Dr Thampi in response to the MPT’s earlier finding that Patient A had suffered psychological harm. In summary, Dr Thampi had submitted that, as the court found in R (El- Baroudy) v. General Medical Council [2013] EWHC 2894 (Admin) at para. 34, where the practitioner faced no allegation that the alleged misconduct caused any harm, the MPT could make no findings on causation when considering impairment. The Legally Qualified Chair’s advice to her fellow panel members on this question is recorded at paras. 26 and 27 of the determination:

There was some discussion of Patient A’s vulnerability. The panel concluded that although Patient A was in a vulnerable position because she was in stirrups and receiving an epidural, she was not a vulnerable patient. Vulnerability was not, therefore, an aggravating feature and the MPT found no other aggravating features: para. 28.

The MPT identified four mitigating factors: Dr Thampi’s expression of regret and remorse; her insight and remediation; the lapse of time (by then, more than eight years) since the birth of Patient A’s baby and the absence of any repetition of the proven failures or any further concerns raised about Dr Thampi’s practice during that time and the isolated nature of the incident which involved only one patient: paras. 30 and 31.

The MPT first considered whether to conclude the case by taking no action: paras. 32-40. The relevant parts of the determination are as follows:

The MPT declined to impose conditions because of the seriousness of its findings (paras. 41-45). At para. 45, the panel considered the consequences of suspension for Dr Thampi’s employment:

The panel next turned to suspension of Dr Thampi’s registration. Having considered the relevant parts of the Sanctions Guidance, the panel concluded that suspension was appropriate and proportionate: paras. 51 and 52. In essence, the seriousness of its findings outweighed the absence of aggravating factors and identified mitigation. The MPT concluded, at para. 52 of the determination, that:

In deciding the length of the suspension, the MPT sought to balance the seriousness of its findings and the mitigation advanced by Dr Thampi. It also emphasised that it had not found impairment on the ground of public/patient safety and wellbeing and had weighed Dr Thampi’s interests and the public interest: para. 55. In the circumstances, the MPT decided that a short suspension of three weeks was sufficient: para. 56.

The relevant legal framework is contained in the Act, the General Medical Council (Fitness to Practise) Rules Order in Council 2004 (“the Rules”) and the GMC’s Sanctions Guidance (February 2024) (“the Sanctions Guidance”).

The GMC’s overarching objective in the exercise of its functions is the protection of the public: s. 1(1A) of the Act. Attainment of that objective involves the maintenance and promotion of public confidence in the medical profession and proper professional standards and conduct of members of the profession: s. 1(1B) of the Act.

The MPT’s role is to determine the facts, make findings on the allegations and then determine whether Dr Thampi’s fitness to practise was impaired by misconduct and, if so, to decide what sanction, if any, should be imposed.

Section 40 of the Act provides a right of appeal to the High Court against a sanction imposed by the MPT. It materially provides that:

Appeals are by way of re-hearing: CPR PD 52D, para. 19.1. The court should allow the appeal if the MPT’s decision was wrong or unjust because of serious procedural or other irregularity: CPR 52.21(3)(a). If the court considers the MPT’s ruling to be wrong or unjust due to serious procedural irregularity or other irregularity in the proceedings below, the court may allow the appeal, substitute any decision which the MPT could have made or remit it back for further consideration.

The parties agreed that in Sastry and Okpara v. General Medical Council [2021] EWCA Civ 623, Nicola Davies LJ set out, at para. 102, the principles that should guide the court’s approach to the appeal:

In relation to the proper approach to sanction, the court is required to make its own judgment on whether the sanction was excessive and disproportionate: Sastry, para. 110. Appropriate deference is to be paid to the MPT’s determinations in s. 40 appeals but the court must not abrogate its own duty in deciding whether the sanction imposed was wrong, that is to say, whether it was appropriate and necessary in the public interest: Sastry, para. 112.

As indicated in para. 20 above, a doctor’s fitness to practise is impaired if s/he has in the past acted and/or is liable in the future to act so as to put the patient or patients at unwarranted risk of harm; and/or has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession: Council for Healthcare Regulatory Excellence v. Nursing & Midwifery Council and Grant [2011] EWHC 927 (Admin), para. 76.

More generally, in Cheatle v. General Medical Council [2009] EWHC 645 (Admin) Cranston J held, at para. 22, that:

The Sanctions Guidance provides advice to the MPT on imposing sanctions on a doctor’s registration, including why a tribunal should impose sanctions and what factors it should consider: para. 1. Its aim is to provide a link between two regulatory roles, namely the setting of standards for the medical profession and taking action when a doctor’s fitness to practise is called into question because s/he has not met the required standards: para. 1.

As its title suggests, the purpose of the Sanctions Guidance is not to dictate to panels how they must proceed but to help them make fair, consistent and transparent decisions. It is indicative, not prescriptive. In other words, the Sanctions Guidance is not to be read as if it were statute: General Medical Council v. Gilbert [2026] EWCA Civ 53, para. 60; Professional Standards Authority v. Health and Care Professions Council and Doree [2017] EWCA Civ 319, para. 26.

The following parts of the Sanctions Guidance are relevant:

Dr Thampi’s fundamental point is that the MPT’s decision on impairment was flawed because it considered and attached weight to the purported emotional impact on Patient A which was inappropriately described as “psychological harm”. The MPT wrongly attributed such harm to the proved failings although no causative failing was alleged and the purported impact on Patient A was not that found by the MPT. In support of the submission, Ms Lydia Barnfather, counsel for Dr Thampi, relied on four particular points:

In response, Ms Alexis Hearnden, counsel for the GMC, made four points:

Two principal issues arise: did the panel err in concluding that Patient A suffered “psychological harm”; if so, did that error vitiate the panel’s decision that Dr Thampi’s fitness to practise was impaired.

As to the former, four points arise in response to the panel’s finding that, at para. 77 of the impairment determination, “psychological harm was caused to Patient A”:

Although I accept that the MPT was entitled to take into account the impact on Patient A of the proven failings, nonetheless the panel erred when it concluded that Patient A had suffered “psychological harm” as a result of those failings. There was no such allegation before the MPT; there was no expert evidence or relevant reasoning to support the conclusion and Dr Thampi was unfairly denied the opportunity to respond in evidence and submissions.

The second issue is whether the panel’s error vitiated its overall conclusion on impairment. In my judgment, it did not. As the GMC submitted, the clear gravamen of the misconduct was Dr Thampi’s failure to obtain informed consent and to communicate appropriately with Patient A. That point was made clear throughout the impairment determination: see, for example, paras. 64, 66, 89 and 90. Likewise, the defining feature of the case was clearly articulated when the panel reached its conclusion that a finding of impairment was in the public interest: Patient A was pressured into the reluctant acceptance of the use of forceps as the only way to deliver her baby, a course for which Dr Thampi had not obtained informed consent: para. 90 of the impairment determination. Although the panel fell into error on the question of “psychological harm”, its finding of impairment was squarely based on the two proven failings and, having carefully taken into account the various positive factors in Dr Thampi’s favour, its assessment of their seriousness. I therefore accept Ms Hearnden’s submission that, for the clear reasons given at para. 90, the nature and seriousness of the two established failings warranted a finding of impairment on the grounds of public confidence and standards.

For the sake of completeness, I reject Ms Barnfather’s submission that the panel was wrong to emphasise that Patient A was in a vulnerable position. As Ms Hearnden submitted, the panel accepted and applied that very point that Ms Barnfather had urged upon them and which fairly reflected the situation in which Patient A found herself, that is to say, in stirrups and receiving an epidural.

If I am wrong and the error fatally undermined the panel’s decision in impairment, nonetheless I would have concluded that a finding of impairment was justified to maintain both public confidence and professional standards. On the basis of the facts as found proved by the MPT, the linked failures to communicate appropriately and to obtain informed consent are serious. The importance of an effective working partnership between doctor and patient is emphasised in the 2008 Consent Guidance. Good communication lies at its heart: it ensures that the treating clinician can explain the relevant risks and benefits of a particular treatment to allow the patient to make an informed decision about what to do. As the panel observed in para. 90 of its impairment determination, patients place trust in doctors to give them the information they need and to listen to them. Notwithstanding her undoubted competence and experience as a clinician, Dr Thampi did not do so on this occasion.

Ground 1, therefore, fails.

The MPT found many substantial factors in her favour: the case was an isolated incident involving one patient; there were no findings of clinical negligence; there was no history of fitness to practise concerns or findings; there was no entrenched attitude; the proved failures were remediable; Dr Thampi had apologised and remediated the concerns; there was a “vast array of positive testimonials, appraisal documentation and all patient and colleague feedback was positive” and she was considered to be a “safe, compassionate and skilled clinician with excellent communication skills” and she had insight and there was a low risk of repetition.

Set against those findings, the MPT attached no sufficient weight to four points: first, the proved failings arose from a misjudgement made in good faith and that Dr Thampi had the interests of Patient A and her baby throughout; secondly, the events are “exceptionally historic”; thirdly, Patient A’s complaint was resolved by the Trust with a first written warning; finally, responsibility for the delay in concluding matters lay with the GMC which had been slow to investigate and serve its case. It is said that these matters are highly relevant to public confidence in the profession. In short, the MPT placed inappropriate weight on the putative harm suffered by Patient A and insufficient weight on the four points which tended to reduce the public interest requirement for a finding of current impairment.

Ms Hearnden submitted that it is clear that the MPT identified the relevant mitigating considerations at paras. 66 and 77 of its determination. Although the low risk of repetition was accepted, nonetheless the misconduct was considered serious because of the nature and extent of the departures from GMP and the relevant parts of the GMC’s 2008 Consent Guidance. Ultimately, a patient in a vulnerable position had undergone a procedure that she did not want.

Ms Hearnden made two further points: first, much of the argument now relied upon had been advanced before and considered by the MPT which had appropriately calibrated Dr Thampi’s culpability. For instance, although Dr Thampi submitted that no sufficient weight had been attached to the fact that the case was one of misjudgement in good faith, the point ignored the MPT’s rejection of the suggestion of arrogance, an entrenched attitude or bad faith.

Secondly, notwithstanding the argument that the case was “exceptionally historic”, no abuse of process or stay argument based on delay had ever been made by Dr Thampi. The passage of time and the point that the Trust’s investigation had resulted in a first written warning were all noted and considered by the MPT but were insufficient to alter its assessment of what was necessary to maintain public confidence.

As is clear from, for example, paras. 66, 77, 83-87 and 89 of the impairment determination, the panel was consistently careful to identify and consider the significant points which weighed in Dr Thampi’s favour. The panel consistently recognised the isolated nature of the case and the fact that it concerned only one patient; the absence of any clinical negligence; Dr Thampi’s remediation work, insight and apology; the absence of any repetition of the proven failings and the low prospect of repetition in the future. The panel also considered the substance of the many supportive references given by colleagues and others.

As to the particular points raised in ground 2, the MPT rejected the GMC’s submission that the misconduct was characterised by arrogance or an entrenched attitude: see para. 79 of the impairment determination. There is no suggestion that bad faith was found to be a relevant feature of the case. The panel noted the fact that the Trust’s internal disciplinary process had resulted in Dr Thampi receiving a first written warning (at para. 44) but the point was not one on which Ms Barnfather placed much emphasis or weight in her submissions to the MPT. Similarly, the panel also had regard to the time that had passed between the incident on 24 October 2016 and the start of the hearings in September 2024 and, more generally, the lengthy period it had taken to bring the matter to a hearing: para. 44. That said, as Ms Hearnden submitted, this was not a case where Ms Barnfather had sought to stay the proceedings because the delay so “exceptionally historic” as to be abusive. Also, the panel had regard to the time that had elapsed since October 2016 when considering the absence of any repetition since the incident.

Ultimately, the many positive significant points in Dr Thampi’s favour (as well as those raised in ground 2) were conscientiously considered by the panel. But, in the final analysis, they were outweighed by the panel’s assessment of the seriousness of the failure to obtain informed consent and to communicate appropriately with Patient A. In my judgment, for the reasons set out above, the panel’s assessment of the seriousness of the proven failings was carefully informed by the positive points relied upon by Dr Thampi and appropriately calibrated in reaching its decision that a finding of impairment was justified.

Accordingly, ground 2 fails.

Ms Barnfather submitted that because its assessment of the seriousness of the misconduct and the wider public interest was flawed, the MPT’s consideration of sanction was also flawed. In essence, it is said that although the MPT sought to correct its mistaken consideration of “psychological harm” by way of the Chair’s directions at the sanction stage, nonetheless its assessment of seriousness and the public interest was “in no small part driven by its mistaken consideration of the purported impact on Patient A”. Moreover, the MPT had failed to attach sufficient weight to the many positive factors in Dr Thampi’s favour.

In particular, Ms Barnfather contended that the public would have been aware of four relevant matters which should have been considered by the MPT: first, the failure to obtain informed consent to the use of forceps arose, on its own findings, from a misjudgement made in good faith because Dr Thampi thought that she could deliver the baby using the vacuum device and so forceps would be unnecessary; secondly, it was not found proved that Dr Thampi had been advised about Patient A’s reservations about the use of forceps before 6.26 p.m. and so there had been no contributory failures by others; thirdly, there had been some (albeit inadequate) discussion of forceps with Patient A and, importantly, Dr Thampi was found to have taken the best course of action (para. 272 of the determination on the facts); fourthly, Dr Thampi faced an “increasingly difficult and hostile environment” with Patient A and her mother who were both verbally abusive to her (para. 271 of the determination on the facts).

Ms Hearnden’s response was three-fold: first, at stage 3, Ms Barnfather submitted to the MPT that it should refrain from consideration of “psychological harm” in its assessment of the public interest. The Legally Qualified Chair was prompted to give advice to that effect which was followed. In the circumstances, there is nothing to suggest that the assessment of the public interest was “inevitably contaminated”. Secondly, although the reasonably informed bystander was not expressly cited in its determination on sanction, the MPT identified and calibrated the seriousness of the proved failings and the need for action to mark that seriousness before turning to the public interest. Thirdly, the various mitigating factors relied upon by Dr Thampi were expressly acknowledged by the MPT in considering sanction.

Ground 3 rests on the contentions that the panel’s assessment of the seriousness of the misconduct and the wider public interest was flawed. As those contentions have been rejected, the foundation of ground 3 has mostly (but not entirely) fallen away. I should, therefore, address the principal points argued by Ms Barnfather.

First, no criticism is made of the substance of the Legally Qualified Chair’s advice to the panel that it should not consider “psychological harm” when assessing the public interest. Notably, there is nothing in the sanction determination that suggests that the advice was ignored in any way. In the circumstances, there is nothing in the sanction determination that supports Ms Barnfather’s submission that the panel’s assessment of the seriousness of the failings or the public interest was “driven” by its conclusion about Patient A’s “psychological harm”. On the contrary, as was the case with the impairment determination, the substance of the sanction determination shows that the panel was consistently focussed on the seriousness of the proven failings.

Secondly, the sanction determination followed the same approach as the impairment decision in carefully (and repeatedly) setting out the many significant factors in Dr Thampi’s favour. However, in considering the public interest the panel did not explicitly refer to the informed bystander nor did it have express regard to the four points summarised in para. 60 above. Having considered the sanction determination, in my judgment, that omission was not material. The panel had carefully considered the factors relevant to the seriousness of the conduct and identified the principal points in favour of Dr Thampi. In light of that assessment, the MPT reasonably reached the effective view that the dominant consideration was impact of the serious failing to obtain informed consent on public confidence. Given that reasonable conclusion, the four points identified in para. 60 would have made little, if any, difference in the assessment of the public interest. Ground 3, therefore, fails.

The MPT’s assessment of sanction proceeded on the erroneous basis that only exceptional circumstances justify a conclusion that no action is necessary. It is said that there is nothing in the Act or the Rules that require a threshold of exceptionality to be met to take no action. A finding of impairment may, on the facts of a particular case, be sufficient to satisfy the public interest. In support of her short point, Ms Barnfather relied on two relatively recent MPT decisions (GMC v. Fard and GMC v. Thompson) in which no action was considered appropriate following a finding of impairment. On the basis of those two cases, it was submitted that the MPT has applied a variable and inconsistent approach to the circumstances in which no action is justified.

The GMC contended that the determination on sanction should be read as a whole. If that is done, the MPT plainly regarded the proved departures from GMP to be too serious to justify no action. In short, the suggestion that the threshold for no action was set too high ignores the totality of the MPT’s assessment and the “authoritative steer” given by the Sanctions Guidance: GMC v. Khetyar [2018] EWHC 813 (Admin), para. 22 per Andrew Baker J.

In answer to Ms Barnfather’s reliance on the Fard and Thompson decisions, Ms Hearnden submitted that care should be taken in attempting a comparative exercise in cases where the MPT had the advantage of hearing live evidence and submissions and, importantly, where the facts of the relevant misconduct will vary. Also, the mere fact that in other cases the MPT has been satisfied that a finding of impairment sends a sufficient message to the profession and the public does not undermine the MPT’s considered conclusion that a three-week suspension was required to mark the gravity of the proved failings.

At the end of the hearing, I asked for further written submissions on the status of the Sanctions Guidance and the parties’ views on how paras. 20 and 68 of the Sanctions Guidance interrelate (if at all). On the former, the parties helpfully drew my attention of the Court of Appeal’s decision in General Medical Council v. Gilbert [2026] EWCA Civ 53 which was handed down after the hearing. On the latter, the principal points were that para. 20 emphasises proportionality and there is no suggestion that para. 68 imposes a threshold of exceptionality when a panel is considering taking no action after a finding of impairment.

Mindful of the Sanction Guidance’s purpose (discussed at paras. 39 and 40 above), para. 68 does not prescribe a threshold of exceptional circumstances to justify a decision not to take action against a practitioner whose fitness to practise has been found to be impaired. As Ms Barnfather submitted (and I accept), para. 68 simply says that there may be exceptional circumstances which justify no action. Para. 68 reminds a panel that no action is an unusual result following a finding of impairment. Ultimately, the panel must reach its own view on the facts of each case.

Having carefully read para. 40 (quoted in para. 26 above) within the broader context of the sanction determination, it appears that the panel have applied a threshold of exceptionality when considering whether to take no action. Although the panel effectively observed in the second sentence that no action would not meet the seriousness of the case, the opening sentence stated that “ … the Tribunal did not consider there to be exceptional circumstances in this case that justified it taking no action to protect the public interest.” By placing exceptionality at the forefront of its reasoning, the panel appear to have applied it as a threshold and not as a reminder that such an outcome is unusual following a finding of impairment. For that reason, ground 4 succeeds.

Finally, I found that the Fard and Thompson decisions provided little help in deciding this case. Their facts and the proven failings were materially different from Dr Thampi’s case and Ms Hearnden was right to warn against attempting any comparative analysis.

Ms Barnfather contends that although the MPT paid “lip service” to the question of proportionality, it failed to take into account the undisputed evidence that any period of suspension would result in the certain termination of Dr Thampi’s employment and, given the present stage of her career, the potential curtailment of her professional life. In support, it was submitted that because of the interim conditions imposed on her registration, Dr Thampi was unable to find a permanent position but has worked under a locum contract which expressly provided for immediate termination should she lose her registration.

Ms Barnfather made two further points: first, instead of weighing the effect of an order of suspension on Dr Thampi and the public, the MPT said that it did not wish her employment to be terminated but that it recognised that it may happen: para. 45 (quoted in para. 27 above). The defining point, in Ms Barnfather’s submission, was that the unequivocal evidence is that the locum contract will be terminated on suspension. Therefore, proportionality appeared to have been weighed against a hypothetical, not an actual, situation. Secondly, the MPT failed properly to recognise the consequence of a suspension for Dr Thampi and failed adequately to assess the public interest in retaining her name on the register. In particular, the short duration of the suspension indicated a “very marginal need” for the order and hope that Dr Thampi’s locum contract would not be terminated.

The GMC’s essential submission is that ground 5 rehearses matters which were put before and properly considered by the MPT. In particular, the MPT sought and heard evidence on the question whether Dr Thampi’s locum contract would be terminated in the event of an order of suspension. It also considered the question of proportionality and balanced the consequences of a suspension for Dr Thampi (which they recognised may include the end of her locum contract) with countervailing significant considerations such as the need to maintain public confidence, to uphold proper professional standards and to mark the seriousness of the proved failings. Ultimately, as Bingham MR observed in the well-known passage in Bolton v. Law Society [1994] 1 WLR 512 at 519, “the reputation of the profession is more important than the fortunes of any individual member. Membership of a profession brings many benefits, but that is part of the price.” In those circumstances, a three-week suspension was neither excessive nor disproportionate.

The question is whether the panel failed to attach sufficient weight to the fact that Dr Thampi would be dismissed if her registration was suspended.

Dr Thampi’s contract of employment was in evidence before the panel. Cl. 12 of the contract provides that it is a condition of her employment that Dr Thampi is and remains a fully registered medical practitioner; is included on the Specialist Register and, pertinently, continues to hold a licence to practise. The panel also had two e-mails from Mr Elvish Veeramootoo, the General Manager of Gynaecology and Obstetrics at Dr Thampi’s current hospital (both dated 9 May 2025), which stated clearly that her contract of employment would be immediately terminated if her registration were suspended. The evidence on the consequences of suspension was, therefore, unambiguous.

In considering sanction and weighing Dr Thampi’s interests and the public interest, the panel failed to recognise the clarity of the evidence on the prospect of dismissal should her registration be suspended. It hoped to avoid the consequences of suspension by imposing a relatively brief period but in so doing, the panel effectively ignored the stark reality as evidenced by cl. 12 of the contract and Mr Veeramootoo’s e-mails. There was nothing in the contract, the e-mails or the evidence generally to reassure the panel that Dr Thampi would not lose her job were her registration to be suspended. Certainly, the panel identified no such evidence in the sanction determination. Ms Barnfather neatly encapsulated the point thus: by placing insufficient weight on the evidence and hoping that Dr Thampi would not be dismissed, proportionality was weighed against a hypothetical, not an actual, situation. Notwithstanding the seriousness of the failings, the loss of her job would be out of all proportion to Dr Thampi’s failings especially given the significant mitigation found by the panel.

The MPT did not, therefore, properly apply the principle of proportionality. Ground 5 accordingly succeeds and the suspension of Dr Thampi’s registration is overturned.

I now turn to what sanction, if any, would be necessary and proportionate. The twin failures to obtain informed consent and to communicate appropriately with Patient A were serious. There is also a public interest in ensuring that professional conduct and standards require consistent compliance with the requirement of consent. I also remind myself of the statement of principle from Bolton’s case. That said, there are substantial mitigating factors that weigh heavily in Dr Thampi’s favour: the incident was isolated and involved only one patient; there were no previous concerns or findings about Dr Thampi’s fitness to practise; there was no clinical negligence; Dr Thampi has insight, she expressed a genuine apology and has carried out considerable remediation work. The incident occurred 9½ years ago since when there has been no repetition of the failings. The substance of the testimonials and appraisals relied upon by Dr Thampi is impressive. The consistent themes are her competence, her devoted care of her patients and, importantly, her excellent communication skills. I also note, once more, the evidence that suspension will result in the loss of Dr Thampi’s job.

On the distinctive facts of this case and reminding myself of paras. 20 and 68 of the Sanctions Guidance, the balance between the public interest and the interests of Dr Thampi is best struck by taking no further action beyond the finding of impairment. That finding is necessary, important and sufficient to emphasise the importance of obtaining informed consent to Dr Thampi, the profession and the public. I acknowledge that no action is an unusual course following a finding of impairment but the positive factors in Dr Thampi’s favour are, on any view, significant.

Grounds 1, 2 and 3 fail: consequently, the appeal against impairment is dismissed. Grounds 4 and 5 succeed so the appeal against sanction is allowed and the suspension of Dr Thampi’s registration is overturned. Instead, no further action beyond the finding of impairment is substituted.

Finally, I should like to thank Ms Barnfather and Ms Hearnden for their considerable assistance and the Appellant’s solicitors for the efficient preparation of the bundles.