Dr Sarah Barbara Myhill v General Medical Council [2025] EWHC 1744 (Admin)

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Dr Sarah Barbara Myhill v General Medical Council [2025] EWHC 1744 (Admin) was an appeal brought by a registered doctor against a Medical Practitioners Tribunal decision of 20 November 2024 suspending her registration for 12 months following a review hearing. Mrs Justice Eady dismissed the appeal.

The appellant, who qualified in medicine in 1981 and worked in the NHS for over 20 years, had not worked as a doctor since 2020, instead practising as a naturopath. An earlier MPT (“MPT1”) sitting from November 2022 to January 2023 had found her fitness to practise impaired by reason of misconduct and imposed a nine-month suspension with a review to follow. The appellant had neither attended that hearing nor exercised her statutory right of appeal within the 28-day time limit under section 40 of the Medical Act 1983. MPT1’s findings included failures to provide good clinical care to patients A and B, and promoting agents including vitamin C, iodine, vitamin D and ivermectin to treat and protect against viral and bacterial infections, including coronavirus, without adequately articulating that these were not licensed for such use, were not universally safe at the recommended doses, and risked patient safety and undermined public health.

At the review hearing before a second MPT (“MPT2”) in November 2023, the appellant sought to call three witnesses (the two experts who had given evidence at MPT1 and the chair of that tribunal) in order to challenge the fairness of the original findings. She also presented a 1,352-page bundle and sought to advance what she termed a Bolam defence, contending that her clinical opinions were supported by a body of medical and scientific literature. MPT2 ruled that it could not reopen the findings of MPT1 and that the proposed witness evidence was not relevant to the question it had to determine, namely whether her fitness to practise remained impaired at the time of the review. The appellant’s application to call the witnesses was therefore refused.

In her evidence the appellant maintained that the proceedings before MPT1 had been unfair, that she had been forbidden by the respondent from using patient A’s medical records to defend herself, and that she did not accept the findings of misconduct. She stated that she no longer wished to practise as a doctor and did not consider the issues of insight, remediation or risk of further misconduct relevant to her role as a naturopathic physician. When asked about insight, she responded that her research demonstrated she knew exactly what she was doing and had supplied the evidence base for a Bolam defence. She acknowledged that in the case of patient B she could have done better and should probably have sent the patient to hospital sooner, but maintained that her advice regarding diet and drugs had been proper. She confirmed she had not sought evidence contrary to her views on matters such as mask-wearing as she did not consider it relevant to her defence.

MPT2 found that the appellant had demonstrated only limited insight in relation to patient B and otherwise had not accepted the findings of MPT1, had failed to give weight to competing views, and had engaged in confirmation bias, persuading herself that she was right to the exclusion of other evidence. Her research was targeted at material that asserted her own beliefs rather than demonstrating balanced reading or reflection. MPT2 concluded that there remained a risk to patient safety and that a finding of impairment was necessary to maintain public confidence and proper professional standards. It imposed a further suspension of 12 months with a direction for another review.

Before Dexter Dias J in October 2024, the appellant had applied to adduce fresh evidence in support of her appeal. In a reserved judgment handed down on 3 March 2025 ([2025] EWHC 474 (Admin)), that application was refused on the basis that the evidence could have been obtained with reasonable diligence for the hearing before MPT1, was not credible or apparently credible, would not have had an important influence on the result, did not put an entirely different complexion on the case, and could not be admitted under rule 34(1) of the General Medical Council (Fitness to Practise) Rules 2004 in the context of a High Court statutory appeal.

On the substantive appeal before Mrs Justice Eady, the appellant advanced ten grounds. She represented herself. The respondent appeared by Peter Mant KC. The appellant framed her appeal as pursuing three aims: to establish the unfairness of the respondent’s procedures, to assert the right to freedom of clinical opinion for all doctors, and to escape what she described as relentless prosecution with her reputation intact.

Mrs Justice Eady held that the grounds relating to fairness (grounds 1, 3, 7, 8 and 10) failed. The appellant’s objections to the late service of the respondent’s skeleton argument and the refusal to postpone the review hearing were rejected because the limitations on the scope of a review had been clearly communicated in correspondence and the appellant was not prejudiced. The decision to refuse the calling of the three witnesses was plainly correct because the evidence sought to be adduced related to the fairness of MPT1, which MPT2 had no power to revisit. The review tribunal was required to determine whether the appellant’s fitness to practise was impaired at the time of the review, taking the earlier findings as its starting point. Those findings had not been appealed and were therefore not to be reopened. Ground 1, which attacked the original findings, was without merit because the appellant had chosen not to attend the fitness to practise hearing and had not exercised her statutory right of appeal within the prescribed time. Ground 3, which raised the so-called Bolam defence, also failed because MPT2 was not addressing the same questions as MPT1 and was not revisiting the earlier evidence. In any event, Dexter Dias J had already found that the material relied on was neither credible nor would have been likely to influence the outcome at MPT1, and did not meet the test in Arnold v National Westminster Bank plc [1991] 2 AC 93 for special circumstances permitting reopening of an earlier determination. MPT2 had properly considered the bundle adduced by the appellant and found it demonstrated an entrenched view rather than balanced reflection. Ground 7, relating to patient B, either impermissibly attacked the MPT1 finding or failed to engage with MPT2’s conclusion that the appellant had shown limited insight on this point. Ground 8, concerning patient A, wrongly characterised the earlier non-compliance ruling of 1 October 2020, which had not forbidden the appellant from using the patient’s records but had recognised the respondent’s power to require disclosure; the appellant had chosen not to attend MPT1 to take the point, and in any event MPT1 had found no impairment arising in respect of patient A.

On freedom of expression (grounds 4 and 5), Mrs Justice Eady accepted that the right under article 10 of the European Convention on Human Rights was engaged but held that any interference was prescribed by law, pursued the legitimate aims of public safety and protection of health, and was proportionate. A sanction following a finding of breach of Good Medical Practice was an interference prescribed by law, as held in Adil v GMC [2023] EWCA Civ 1261. The aims were sufficiently important, there was a rational connection between the sanction and those aims, MPT2 had considered lesser sanctions, and the tribunal was best placed by reason of its experience and expertise to determine the necessary measures to protect the public and maintain professional standards. It was not disproportionate to impose a period of suspension to allow the appellant to reflect on her views in the light of other opinions or to consider the need to provide information about limitations or risks of treatment. The appellant was entitled not to accept the earlier findings (per Yusuff v GMC [2018] EWHC 13 (Admin) and Blakeley v GMC [2019] EWHC 905 (Admin)) but that did not render the review decision unfair or disproportionate.

As to outcome (grounds 2, 6 and 9), ground 2 rested entirely on the appellant’s contention that the finding of lack of insight failed to take account of her evidence, a submission already addressed and rejected. Ground 6, invoking article 8 ECHR, contended that the suspension interfered with her ability to carry on her naturopathic practice and reputation. Mrs Justice Eady held that article 8 was not absolute and the interference was justified for the protection of health and the rights of others. The appellant’s particular circumstances, including her wish to be de-registered, had been at the forefront of MPT2’s deliberations. MPT2 had considered taking no action and also considered erasure, but properly concluded that a period of suspension could adequately promote the overriding objective under the Act. This was a judgment best left to the specialist professional tribunal. It had been indicated during the review hearing that, in the absence of outstanding investigations, a request for voluntary erasure might be viewed differently.

Mrs Justice Eady applied the well-established approach on statutory appeal from professional disciplinary tribunals set out in Sastry v GMC [2021] EWCA Civ 623 and Adil, emphasising that although the appeal is by way of rehearing and the court may substitute its own decision, considerable respect and deference is due to the experience and expertise of the professional tribunal, particularly where evaluative judgment depends on assessment of oral evidence. She held that MPT2 had approached its task correctly, had proper regard to all the material before it, and reached a decision that was entirely justified by the evidence. The review decision struck a fair balance and was neither wrong nor disproportionate.

In short, the court dismissed the appeal, holding that the review tribunal had acted within its powers and had not erred in declining to revisit the earlier findings, that the sanction imposed was proportionate and justified by the overriding objective, and that there had been no breach of the appellant’s Convention rights.

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