Bhatti v County Durham and Darlington NHS Foundation Trust: interim injunction refused despite procedural irregularities

The High Court has refused an interim injunction sought by a consultant breast and general surgeon seeking reinstatement to clinical practice, finding that the NHS Trust's most recent restriction decision was rational and grounded in legitimate patient safety and probity concerns.

Mr Amir Ahmed Bhatti had been employed by County Durham and Darlington NHS Foundation Trust since 2005, serving as Clinical Lead for breast services from 2013 to 2024. His exclusion from clinical practice followed a series of adverse external reviews of the Trust's breast service, culminating in a Royal College of Surgeons report in April 2025 that identified unnecessary surgery, weaknesses in MDT governance, and departures from national standards.

The Trust imposed a succession of restrictions on Mr Bhatti's practice: an initial limitation on breast cancer surgery in February 2025, an extension to all clinical work in October 2025, and a maintained restriction confirmed in January 2026 by a new Responsible Officer. Mr Bhatti's application sought the lifting of all three decisions, though the Court confirmed that the operative decision for injunctive purposes was that of January 2026.

Deputy High Court Judge Elizabeth O'Neill applied the American Cyanamid three-stage test, with the heightened merits threshold applicable to mandatory relief under Nottingham Building Society v Eurodynamic Systems. She found no serious issue to be tried in relation to the January 2026 Decision. That decision had been reached in the context of an evolving MHPS investigation, expanded Terms of Reference identifying 21 patients potentially discharged without follow-up during breast cancer investigations, and probity concerns arising from the claimant's dual role as Clinical Lead and director of private companies providing diagnostic services to the Trust.

The judgement addresses an important distinction between restriction and exclusion under the Maintaining High Professional Standards framework. The procedural safeguards prescribed by MHPS — including mandatory case conferences, consultation with the Practitioner Performance Adviser, and four-weekly reviews — apply only to formal exclusions. The Court affirmed that restricting a practitioner to non-clinical duties does not constitute an exclusion, even where the practical effect significantly narrows the scope of available work. However, the judgement introduces a qualification: where a restriction effectively removes all existing workstreams and no alternative duties are provided, the employer should nonetheless consider whether such a far-reaching measure is necessary to protect patient interests, consistent with its obligation of trust and confidence.

On that basis, the Court found the October 2025 Decision open to question, noting the absence of any expressed concern about the claimant's general surgery and the failure to consider whether a complete bar on non-breast clinical work was warranted. This finding did not, however, disturb the outcome. The January 2026 Decision stood on materially different and substantially wider grounds, and the Court declined to allow arguable flaws in an earlier decision to undermine a subsequent one taken on fresh evidence — an approach consistent with Al-Mishlab v Milton Keynes Hospital NHS Foundation Trust.

The judgement confirms that courts will defer considerably to clinical employers on patient safety decisions. Citing Jain v Manchester University NHS Foundation Trust, O'Neill J emphasised that where concerns go to a practitioner's clinical performance, a Trust is entitled to adopt a precautionary approach and the court should give real weight to the professional judgement of the decision-maker, provided it was exercised in good faith.

The claimant was ordered to pay the defendant's costs, summarily assessed at £47,000.