GMC v Grajn: High Court quashes MPT suspension after finding serious under-prosecution

A High Court judge has quashed all determinations made by the Medical Practitioners Tribunal against Dr Andrej Grajn, a transplant surgeon, finding that the General Medical Council had seriously under-prosecuted its own case and that a fresh hearing before a differently constituted tribunal is now required.

Mrs Justice Tipples, sitting in the Administrative Court on 22 May 2026, dismissed Dr Grajn's own appeal against a twelve-month suspension in its entirety, while allowing the GMC's appeal on its first ground and the Professional Standards Authority's appeal on grounds one and two. The combined effect renders the original sanction a nullity.

Background to the proceedings

Dr Grajn, registered with the GMC since 2017, had been employed at the Royal Free London NHS Foundation Trust as a senior clinical fellow and locum consultant in transplant surgery. The MPT hearing in October 2025 concerned two sets of allegations: first, that the Queensland Civil and Administrative Tribunal (QCAT) had in September 2023 found him guilty of professional misconduct for engaging in a sexual relationship with a patient or former patient; and second, that he had failed to disclose that determination to both the GMC and his employer.

QCAT had found that Dr Grajn, while a transplant surgical fellow in Brisbane, had initiated an inappropriate and ultimately sexual relationship with a patient who had undergone renal transplant surgery in February 2016. The patient died by suicide in October 2017. QCAT reprimanded Dr Grajn and disqualified him from applying for re-registration in Australia for two years.

The MPT found all allegations proved, determined that Dr Grajn's fitness to practise was impaired, and imposed a twelve-month suspension with a review hearing. The GMC and PSA both appealed on the basis that the sanction was insufficient; Dr Grajn cross-appealed seeking to quash all findings.

Dr Grajn's appeal dismissed in full

The court rejected each of Dr Grajn's five grounds of appeal. His contention that QCAT lacked jurisdiction because he was no longer registered in Australia at the time of its determination failed: Mrs Justice Tipples held that QCAT's order was plainly a determination falling within section 35C(2)(e) of the Medical Act 1983, and the fact of Dr Grajn's deregistration at the time of the hearing was "neither here nor there." The certified and sealed QCAT order was conclusive evidence under rule 34(4) of the General Medical Practice (Fitness to Practise) Rules 2024.

His argument that paragraph 75 of Good Medical Practice imposed no disclosure duty in the absence of a live registration equally failed. The court held that QCAT's findings related to conduct during his registration, and its sanction of disqualification from re-applying was itself a finding against his registration for the purposes of paragraph 75(c).

Grounds challenging the application of the Grant test on impairment, the proportionality of the sanction, and the adequacy of the MPT's reasons were each dismissed. The court found the MPT had correctly directed itself in law, considered all relevant evidence including testimonials, and was entitled to conclude that Dr Grajn had demonstrated limited insight into his misconduct.

Under-prosecution: the decisive issue

The critical findings, however, concerned the GMC's conduct of its own case. Documentation before the court established that by May 2024 the GMC was aware that Dr Grajn had known since June 2018 of the Australian investigation, had failed to disclose it when applying to the Royal Free Hospital in both 2019 and 2023, and had answered "No" to direct questions about ongoing fitness to practise proceedings on both occasions. Despite this knowledge, the charge referred to the MPT in January 2025 contained no allegation of dishonesty and made no reference to the false answers given on those application forms.

An internal GMC advice note from April 2025, placed before the court, acknowledged a "real risk of under-charging the case." The GMC had nonetheless proceeded to a full MPT hearing in October 2025 without the additional allegations, which were only sent to Dr Grajn for comment in March 2026.

Mrs Justice Tipples held that this constituted a serious procedural irregularity. Dr Grajn's state of mind when deciding not to notify his employer and regulator was, she found, of real significance to both impairment and sanction: had dishonesty been alleged and proved, the outcome may well have been materially different. She was equally critical of the failure to charge the 2019 application form conduct, noting that the GMC had been in possession of the relevant materials before referral.

Outcome and directions

All MPT determinations are quashed. The matter is to be remitted to a freshly constituted MPT for a complete rehearing, to encompass both the original allegations and the additional dishonesty allegations currently with the Case Examiners. The court indicated that proceedings should be dealt with as expeditiously as possible.

The PSA had also sought a costs order against the GMC. Mrs Justice Tipples noted that, given Dr Grajn had acted in person throughout, any such sanction was unlikely to be of practical benefit to him. The question of appropriate directions was reserved for further submissions.