David James v GMC: Court of Appeal upholds decision to remit doctor’s fitness to practise case

The Court of Appeal has dismissed Dr David James’s appeal against a decision to remit an allegation of misconduct to the Medical Practitioners Tribunal Service (MPTS), ruling that the General Medical Council (GMC) should retain the opportunity to determine whether further proceedings are justified.

In David James v General Medical Council [2026] EWCA Civ 1338, Lord Justice Stuart-Smith, with whom Lord Justice Nugee and Lord Justice Fancourt agreed, held that the High Court had properly exercised its discretion under section 40(7) of the Medical Act 1983. The decision leaves open the possibility that the allegation may be withdrawn or reconsidered before a further tribunal hearing.

The case concerns an incident in August 2019, when Dr James, an experienced anaesthetist, was providing anaesthetic care to a patient during a medical emergency. The patient became distressed and moved unpredictably during gaseous induction. Expert evidence accepted that such movement, including removal of the face mask, posed a serious risk to the patient’s life.

Dr James denied slapping the patient, maintaining that any contact occurred while he was attempting to keep the patient’s head still and the mask in position. The MPTS nevertheless found, on the balance of probabilities, that he had slapped the patient. Other allegations, including inappropriate language, excessive analgesia prescribed with an intention to cause retrograde amnesia, and an attempt to prevent the incident being reported, were not proved.

On appeal, Mrs Justice Hill quashed the tribunal’s finding concerning the alleged slap. She identified material deficiencies in its reasoning, including reliance on contradictory evidence, inadequate findings on disputed facts, failure to explain why Dr James was considered unreliable, and insufficient consideration of his evidence and professional standing.

The issue before the Court of Appeal was whether the allegation should be remitted to the MPTS or dismissed entirely. Dr James argued that the prolonged proceedings, the age of the allegation and the repeated involvement of witnesses made a further hearing disproportionate. The incident had already been considered in internal disciplinary proceedings, criminal proceedings and the fitness to practise process. The criminal conviction for common assault was overturned on appeal in 2022.

The court acknowledged the importance of finality, procedural fairness and the risk that delay may affect the quality of evidence and the wellbeing of the doctor concerned. However, these considerations had to be balanced against the statutory objectives of protecting the public, maintaining confidence in the medical profession and upholding professional standards.

Drawing on Hawkins v Health and Care Professions Council [2023] EWHC 3256 (Admin), Hannigan v Nursing and Midwifery Council [2026] EWHC 62 (Admin) and Southall v GMC [2010] EWCA Civ 484, the court emphasised that remittal requires a fact-sensitive assessment of the interests of justice and the public interest. The regulator’s view is not determinative, but its statutory responsibility is an important consideration.

Lord Justice Stuart-Smith rejected the argument that the High Court had improperly deferred to the specialist disciplinary process. Mrs Justice Hill had considered both parties’ submissions and was entitled to conclude that the proportionality and fairness arguments should be considered by the MPTS, which could assess them in their full procedural and professional context.

The court also noted that rule 28 of the General Medical Council (Fitness to Practise) Rules 2004 provides a mechanism for withdrawing an allegation before a further tribunal hearing. The remittal therefore did not require the GMC to proceed automatically to a rehearing.

The appeal was dismissed, leaving the GMC and MPTS to determine the appropriate next steps in accordance with the statutory framework and the circumstances of the case.