Professional Standards Authority for Health and Social Care v The General Dental Council & Anor

The Dentists Act 1984 (“the 1984 Act”) provides the statutory framework for the regulation of the dental profession and governs the function of the GDC and its statutory committees. Under section 1(1ZA)–(1ZB) of the 1984 Act, the GDC’s overarching objective in exercising its functions is the protection of the public. This objective is pursued through three linked aims:

The 1984 Act, together with the GDC (Fitness to Practise) Rules Order of Council 2006 (“the 2006 Rules”), establishes the fitness to practise regime through which these objectives are delivered. Where an allegation has been investigated and referred onward, Rule 12 of the 2006 Rules provides that the Practise Committee must hold a hearing to consider that allegation. The 1984 Act further defines the scope of the Practise Committee’s jurisdiction. Section 27(2) provides that a dentist’s fitness to practise may be regarded as impaired by reason of misconduct (among other statutory grounds).

Pursuant to section 27B(1), where an allegation is referred to it by the Investigating Committee under section 27A, a Practise Committee is required to investigate the allegation and determine whether a dentist’s fitness to practise is impaired. Where impairment is found, section 27B(6) confers powers on the Practise Committee to impose sanctions, including suspension from the register or erasure, as is necessary to meet the 1984 Act’s public protection and public interest objectives.

The GDC’s guidance, Standards for the Dental Team, sets out the professional standards of conduct expected of all dental professionals and underpins the regulatory framework governing fitness to practise. The guidance emphasises the importance of respectful and lawful conduct towards colleagues and the wider public. Paragraph 6.1.2 requires dental professionals to treat colleagues fairly and with respect in all situations and forms of interaction, and expressly prohibits bullying, harassment and unfair discrimination.

The guidance further makes clear that professional responsibilities extend beyond the immediate clinical setting. Paragraph 9.1 provides that a dentist’s conduct, both at work and in their personal life, must justify patients’ trust and the public’s trust in the dental profession. Paragraph 9.2 reinforces this obligation by requiring dentists to protect patients and colleagues from risks arising from their health, conduct or performance. Paragraphs 9.1.1 and 9.1.2 further require all team members and members of the public to be treated fairly and with dignity and prohibit disparaging remarks about colleagues in front of patients, directing that concerns about colleagues should instead be raised through appropriate channels.

The guidance provides further context as to the seriousness with which breaches of these standards are regarded. In relation to sexual misconduct, paragraphs 74–75 state that such behaviour seriously undermines public confidence in the profession and is to be considered even more serious where it involves an abuse of a position of trust. The guidance directs Practise Committees to be alert to the risks posed to patients, the wider public, and confidence in the profession, and recognises that in cases of serious sexual misconduct there may be a real prospect of current impairment, such that erasure may be the appropriate sanction.

Section 29 of the 2002 Act provides the statutory basis upon which decisions of healthcare regulators may be scrutinised by the courts. Where the PSA refers a case to the High Court, that referral is treated as an appeal pursuant to section 29(7).

The powers of the Court on such an appeal are set out in section 29(8). The Court may:

The Court also has a discretion as to costs.

The appeal is governed procedurally by CPR 52. The applicable test is set out in CPR 52.21; an appeal will only be allowed where the decision under challenge was wrong, or unjust because of a serious procedural or other irregularity.

An appeal brought by a regulator or the PSA under section 29 is not a rehearing of the case but is supervisory in nature. This distinction was authoritatively explained by the Court of Appeal in Sastry v GMC [2012] EWCA Civ 623, where it was held that such appeals proceed by way of review rather than a redetermination of the issues.

The substantive approach to section 29 appeals was established by the Court of Appeal in Council for the Regulation of Healthcare Professionals v (1) GMC (2) Ruscillo [2005] 1 WLR 717. The Court held that the criteria applied by the High Court in deciding whether to allow a PSA appeal are the same as those applied by the PSA in determining whether a sanction was unduly lenient. The essential question is whether, having regard to the material facts, the decision reached gave due weight to protecting the public and maintaining the reputation of the profession. The test is whether the sanction imposed was one which a reasonable tribunal, having regard to the relevant facts and the objectives of the disciplinary regime, could reasonably have imposed. In practical terms, the issue is usually whether the sanction was manifestly inappropriate.

Ruscillo further establishes that the Court may allow a section 29 appeal where serious procedural or other irregularity renders it impossible to determine whether the sanction imposed was unduly lenient. Such irregularities may include a failure to give adequate reasons for the decision, as recognised in CRHP v (1) GDC (2) Marshall [2006] EWHC 1870 (Admin), or under charging which prevents the tribunal from considering the full gravity of the misconduct, as discussed in PSA v (1) GCC (2) Briggs [2014] EWHC 2190 (Admin).

Where allegations of under prosecution arise, the Court must consider whether the regulator ought, on the evidence and applying its own rules, to have brought further allegations, and whether the failure to do so prevents the Court from properly determining whether the sanction imposed was unduly lenient. A case may be rendered fundamentally flawed where the regulator fails to bring the full gravity of the misconduct to the tribunal’s attention, as explained by Singh J in PSA v Jozi [2015] EWHC 764 (Admin).

The general appellate approach was summarised by Cranston J in Yassin v GMC [2015] EWHC 2955 (Admin). The starting point is that the panel’s decision is correct unless and until the contrary is shown. The Court must afford appropriate weight to the tribunal’s status as a specialist body with insight into professional standards, and to its advantage in hearing and seeing witnesses.

Findings of primary fact, particularly those based on credibility, are virtually unassailable on appeal and will only be interfered with if plainly wrong. Secondary findings and inferences attract greater but still limited scrutiny. Evaluative judgments, including those concerning seriousness, impairment and sanction, are akin to jury questions about which reasonable disagreement is possible.

These principles were reaffirmed by the Court of Appeal in Bawa-Garba v GMC [2018] EWCA Civ 1879; [2019] 1 WLR 1929. Decisions on sanction were characterised as “a multi-factorial decision”, attracting appellate restraint. An appellate court may interfere only where there has been an error of principle or where the decision falls outside the bounds of reasonable decision making.

Although appeals under section 29 are ordinarily reviews, there are circumstances in which they proceed by way of rehearing. Even then, the Court will be very slow to interfere with findings of primary fact, regardless of whether the appeal is by way of review or rehearing (PSA v (1) GDC (2) Danial [2024] EWHC 2610 (Admin)).

In cases of sexual misconduct or racist conduct, the courts have recognised that they are particularly well placed to assess what is required to protect the public and maintain confidence in the profession. As a result, the court may attach less weight to the tribunal’s expertise than in clinical performance cases, while still affording the tribunal’s evaluative judgment proper respect (GMC v (1) Gilbert (2) PSA [2026] EWCA Civ 53).

Sexual motivation is not ordinarily capable of proof by direct evidence and must be established by inference from primary facts and surrounding circumstances. Where such inferences depend on credibility assessments, appellate courts must exercise the same caution as applies to challenges to findings of primary fact (Haris v GMC [2021] EWCA Civ 763).

Sexual misconduct does not automatically justify erasure. In Arunachalam v GMC [2018] EWHC 758 (Admin), the High Court emphasised that sanction must be proportionate and reflect the overall gravity of the misconduct, mitigation, insight, and future risk. The Court similarly cautioned in GMC v Shah [2025] EWHC 899 (Admin), that breaches of the Equality Act 2010 (“the 2010 Act”) do not operate as a regulatory trump card mandating findings of serious misconduct or erasure.

Tribunals are required to have regard to sanctions guidance, but such guidance must not be applied mechanistically. In Gilbert, the Court of Appeal stressed that sanction decisions must be based on an evaluation of the overall gravity of the misconduct, rather than a tick box exercise (see also GMC v Khetyar [2018] EWHC 813 (Admin)).

Remediation and insight are matters of evaluative judgment for the tribunal. Appellate courts will be slow to interfere with such assessments unless plainly unsustainable (Gilbert). The Court is not entitled to re-sentence merely because it would have imposed a different sanction (Ashton v GMC [2013] EWHC 943 (Admin)).

Tribunals owe a duty to give reasons. However, reasons must be read as a whole and with appropriate generosity, bearing in mind the professional and practical context in which tribunal decisions are made (Bedesha v National College for Teaching and Leadership [2014] EWHC 1531 (Admin); PSA v (1) GMC (2) Uppal [2015] EWHC 1304 (Admin)). An appeal will only succeed on grounds of inadequate reasons where the appellate court is unable to understand why the tribunal reached its decision (Byrne v GMC [2021] EWHC 2237 (Admin)).

During the 12-day hearing, in addition to other evidence, 5 female witnesses gave oral evidence to the Committee: Witness A, Head Dental Nurse (“WA”), Witness C, Dental Hygienist/Dental Therapist (“WC”), Witness D, Dental Nurse (“WD”), and Witness G, Student Dental Nurse (“WG”), who were all employed at the Practice at the material time, as well as Patient A (“PA”).

The proceedings were initiated as a result of a complaint by WD to the GDC in April 2023. In May 2023, an Interim Orders Committee first imposed conditions restricting the Registrant’s practice, which were extended by the High Court pending final determination of the allegations. The complaint was investigated leading to a range of allegations involving different female members of staff. On the 6 August 2024, the Allegations were referred to the Committee by the GDC Case Examiners. The substantive hearing took place between 7-22 July 2025. The Registrant attended and was represented by counsel. He denied all of the allegation’s, bar making some limited factual admissions that some conduct had occurred, but that it was not inappropriate.

Following the hearing, the Committee found the majority of the factual allegations proved against the Registrant, but that his conduct as alleged at 1(a), 1(b), 1(c), 1(e), 1(i), 1(j), 1(k), 1(n), 1(o), 1(p) and 4(a) and 4(b) of the particulars was not sexually motivated. In respect of 1(g), the Committee found that the comments were sexually motivated. In respect of 1(a)(i), 1(a)(ii), 1(b), 1(c) and 1(i), the Committee found that the comments made were inappropriate, but not of a sexual nature. In respect of 1(e), 1(j), 1(n), and 1(p), the Committee found that the comments made were inappropriate and of a sexual nature. In respect of 1(a)(iii-iv), 1(k), 1(h)(iii), 1(o), 2(a), 2(g), 3(a)(ii), 4(b), 5(a) and 5(d), the Committee found these allegations were not proved. The Committee found that the only sexually motivated misconduct, 1(g) committed by the Registrant was in the context of an invitation to WG to sit on his knee.

The Committee found that there was a risk of repetition of the Registrant’s inappropriate, sexual and discriminatory behaviour and therefore determined that a finding of impairment was required on public protection grounds, noting only partial insight and a lack of full remorse. The Committee also found impairment on public interest grounds, concluding that he had abused his position of trust as a senior member and brought the dental profession into disrepute.

In considering sanctions, the Committee considered the aggravating factors, as being the abuse of his position and the power imbalance between the Registrant and his dental colleagues, including junior and student dental colleagues, and that the misconduct was repeated over a period of several years.

As far as WG was concerned (see further below), the Committee determined that the “sexually motivated conduct is serious” and found the comments made were “sexually intimidating” but bore in mind this related to “one finding in the context of one conversation” and went on to find that the Registrant was not “trying to engage in a sexual relationship with her or any of [his] female colleagues”.

The Committee made no reference at the sanction stage to his discriminatory behaviour, nor considered the seriousness of the sexual (not non-sexually motivated) behaviour. It found that erasure would be disproportionate, as the behaviour was not fundamentally incompatible with remaining on the register. It imposed a suspension of 6-months, with review, considering that this would allow the Registrant “sufficient time to reflect on [his] misconduct and be able to address fully the limitations in [his] insight and remediation”. The determination was then reviewed by the GDC Quality Assurance Group.

On the 8 September 2025, the GDC wrote to the PSA to notify it of the GDC’s concerns with the determination. On the 6 October 2025, the PSA filed its Grounds of Appeal and served them on the GDC on the 7 October 2025. On the 12 January 2026, the GDC confirmed they would not contest the appeal. On the 9 February 2026, the suspension was reviewed by the GDC Committee, and the suspension was terminated and substituted for an order of conditions for a period of 18-months, with an immediate order of conditions imposed.

At the hearing before me I was taken through the Committee’s findings in numerical order. However, for the purpose of considering the pattern of behaviour and its development over time it is helpful to set out the proven allegations in a broadly chronological sequence as follows:

The PSA’s overarching submissions are that the Committee’s findings were irrational and that it determined incorrectly that some allegations were not sexual in nature. The PSA submits that the Registrant should have faced an allegation that his conduct at 1(l) amounted to sexual harassment towards WA, WD and WG. It submits that there is clear evidence of unwanted conduct of a sexual nature, that the act violated each colleague’s dignity or created an intimidating, hostile, degrading, humiliating and/or offensive environment, and that these findings would have affected the Committee’s approach to misconduct and seriousness. It submits that the Committee failed at the sanction stage to engage with the true seriousness of the nature of the conduct, the lack of mitigation, and the evidence of the Registrant’s deep-seated attitudinal issues. It submits that the Committee failed to arrive at a sanction which was sufficient to protect the public, maintain public confidence in the profession, and maintain proper professional standards and conduct for members of the profession. The PSA submits, as its primary case, that the Committee should have imposed erasure. The Grounds of Appeal are as follows.

The Committee found the Registrant had stated to WD that it was “a shame” that a female patient had “a pretty face but such a small chest” (1(l)). The Committee found this to be proved and inappropriate and considered the comment “was a personal comment about a patient’s appearance” but there was “nothing to suggest that it was made in a sexual manner.”

The PSA submits that this finding was irrational and wrong. They submit that commenting on a women’s chest size, without any clinical or other justification, is overwhelmingly likely to be sexual in nature. The PSA submit that it was unclear what further evidence the Committee considered was necessary to determine that the comment was made in a “sexual manner” or in what manner the Committee considered it was in fact made.

The PSA submits that the Registrant was passing judgment upon the appearance of a female patient. It argues that the Committee was wrong to find the allegation not proved as sexual, particularly in the context of an established propensity to make sexualised comments to colleagues.

The PSA submits that the Court is entitled to draw inferences which are justified upon the evidence and that a reasonable inference can be drawn that this comment was sexual in its nature (see GMC v Haris [2020] EWHC 2518 (Admin) [47]).

The Committee found that allegations 1(e), 1(f), 1(n) and 1(p), whilst proved, inappropriate, and sexual in nature, were not sexually motivated.

The PSA submits that the Committee did not provide individual reasoning for finding that each allegation was not sexually motivated, and instead made a blanket finding that:

“… the comments made were inappropriate and of a sexual nature. However, it is not satisfied, that these were done either in the pursuit of sexual gratification or in the pursuit of a future sexual relationship. In reaching its decision, the Committee has borne in mind that there is no evidence that you were actively trying to engage in a sexual relationship with your female colleagues. For example, there was no evidence that you contacted your female colleagues outside of the professional environment.

Regarding the comments you made about colleagues, the Committee was not able to exclude the possibility that the comments were made out of an attempt for you to assert your authority in an inappropriate and unpleasant fashion. It therefore did not infer sexual gratification from your actions.”

In relation to allegation 1(e), the evidence that the Committee accepted was that the Registrant had, on each occasion, without invitation, initiated conversations about his female colleagues’ sex lives, namely:

These questions were wholly unsolicited. The Registrant’s case at the hearing had been that they did not occur.

In relation to allegation 1(n), the Committee accepted that WG walked away from a conversation about the Registrant sleeping naked in hot weather, leading to his comment about “dick pictures”.

Regarding allegation 1(p), the Committee accepted that the Registrant told WA about his “ranking system”, speaking about who he would like to “shag”. The Committee accepted that WA did not invite this conversation, nor initiate it.

The PSA submits that the findings that these conversations were not sexually motivated are irrational and wholly against the weight of the evidence. Sexual motive is defined in Basson v GMC [2018] EWHC 505 (Admin) at [14], as “conduct [that] was done either in pursuit of sexual gratification or in pursuit of a future sexual relationship”. The PSA submits that the issue of sexual motivation is one that cannot be “proved by direct observation. It can only be proved by inference or deduction from the surrounding evidence” (Basson [17]).

The PSA submits that the Committee’s finding it was “not able to exclude the possibility that the comments were made out of an attempt for [the Registrant] to assert his authority in an inappropriate and unpleasant fashion” is without logical foundation. The PSA submits that there was no correlation with any assertation of authority, and that the statements were clearly directed at engaging colleagues in sexual conversations in the workplace with the same type of questions being asked of the same people. The PSA submits that there is a clear inference to be drawn from the Registrant initiating these conversations, that he gained some form of titillation from these inherently sexual questions and comments, and his obvious intention was to engage his colleagues in conversations of an overtly sexual nature, which provided him with some level of sexual gratification.

The GDC is subject to the public sector equality duty imposed by section 149 of the 2010 Act, which provides:

“Public sector equality duty

(1)

A public authority must, in the exercise of its functions, have due regard to the need to—

(a)

eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act (…)

(2)

A person who is not a public authority, but who exercises public functions must, in the exercise of those functions, have due regard to the matters mentioned in subsection (1).”

The PSA provides by way of an example that Person A will be taken to sexually harass Person B, contrary to section 26 of the 2010 Act, where A engages in unwanted conduct related to sex, or of a sexual nature, and the conduct has the purpose or effect of violating B’s dignity, or creating an intimidating, hostile, degrading, humiliating, or offensive environment for B. The PSA submits that the section 26 definition to which the GDC was to have “due regard” depends on either the “purpose or effect of conduct”.

As Griffiths J explained in PSA v (1) HCPC (2) Yong [2012] EWHC 52 (Admin) at [63]:

“The word ‘or’ shows that harassment cannot be displaced merely by a lack of intent on the part of the alleged perpetrator if the effect is ‘violating… dignity’ or ‘creating an intimidating, hostile, degrading, humiliating or offensive environment’ for the alleged victim”.

The PSA submit that WA, WD, and WG described a clear course of unwanted, inappropriate conduct by the Registrant, which was directed towards them, of a sexual nature, which they found offensive or upsetting, and in violation of their dignity. WD expressly described the Registrant’s conduct as “sexual harassment” which she found “degrading”. WA, who was responsible for drawing up rotas at the Practice, described his behaviour as having become so problematic that “no one wanted to work with [him], so it was becoming a nightmare. I couldn’t put the Registrant with anyone who was young”.

The PSA argues that the real gravity of the misconduct in this case was the persistent, widespread, sexualised behaviour of the Registrant, in the context of clear professional power imbalances, which needed to be viewed cumulatively, as part of a course of conduct.

The PSA submits that the way the case was presented invited the Committee to consider each allegation in isolation, referencing the Registrant’s motivation. In contrast the PSA submits that the misconduct referenced concerned the repeated, sexualised behaviour, which, irrespective of motivation, when viewed in the context of the Registrant’s previous actions, on any proper assessment, cumulatively amounted to sexual harassment.

In PSA v (1) The Health and Care Professions Council (2) Doree [2017] EWCA Civ 319 at [58], Lindblom LJ made clear, when considering under prosecution, that “the crucial question” is whether it could be said if the amended charges that were put before the committee had then been found proved that “this might have made a significant difference to the Panel’s conclusions on misconduct and fitness to practise, or led them to impose a more severe sanction than they did”.

The PSA submits that if sexual harassment had been alleged, the Committee would have been required to turn its mind to the degrading, hostile, humiliating and offensive environment created by the Registrant. The Appellant further submits that the Committee would then have been likely to have found that allegations 1(a), 1(b), 1(c) and 1(l) did form part of harassing conduct, and they would have been further required to consider the guidance related to harassment in the GDC’s Fitness to Practise: Guidance for the Practice Committee, paragraphs 15-27, where it is noted that “harassment cannot be excused, condoned or tolerated within the dental profession” and specific aggravating factors for consideration are identified.

The PSA submits that had sexual harassment been charged and proved, the Committee would have recognised such behaviour amounted to a criminal offence and would have considered misconduct through the lens of sexual harassment, this plainly would have impacted the assessment of seriousness, and thus the approach to sanction.

The PSA submits that the GDC’s Sanction Guidance expressly states that one of the factors which might indicate that suspension is appropriate is “there is no evidence of harmful deep-seated personality or professional attitudinal problems (which might make erasure the appropriate order)”. The Committee was addressed directly on this point by the GDC’s counsel in their closing:

“It is the GDC’s submission that there is, in this case, with evidence; evidence of harmful, deep-seated attitudinal problems”.

The PSA submit that the Committee did not directly refer to this at all within its decision, and that the Committee appears to have found that this factor was not engaged by not referring to it at [79] of its determination. The PSA states that the Committee does not address what impact this had upon its decision and refer to the behaviour being “attitudinal” without further explanation.

The PSA submit that this is a clear case where harmful deep-seated personality and attitudinal problems were present. They submit that even on the findings the Committee did make, the Registrant had engaged in racist, sexist, sexualised, sexually motivated and offensive behaviour, primarily directed towards female colleagues; conduct which persisted over several years. The PSA submits that wide-ranging conduct, of this type, occurring for so long, is itself indicative of deep-seated attitudinal concerns.

At the time of the hearing before the Committee, 2 ½ years post referral, the Committee accepted that the Registrant had “not fully expressed remorse for [his] actions and a confirmation of a change in [his] values in regard to professional behaviour and professional relationships” and there still remained “a risk of repetition of the inappropriate and unprofessional behaviour”. The PSA submits that there was evidence therefore of “harmful deep-seated personality or professional attitudinal problems”, and this is a factor that is noted as being indicative of erasure and requires proper consideration and an explanation as to how suspension was still considered appropriate.

The PSA submits that at the sanction stage, the Committee did not address and made no reference to the discriminatory behaviour, or the sexual (but not sexually motivated) behaviour, nor the seriousness of the widespread sexual behaviour towards WA, WD and WG, which were all serious matters raising fundamental concerns about the Registrant’s suitability to remain upon the register.

The gravity which should be afforded to sexual misconduct cases is well established in the case law. In Arunachalam, Kerr J observed at [58-62]:

“58.

…Such cases are inherently serious, such that they may well lead to erasure, even for a first-time offender with a good clinical record. Often, maintaining public confidence in the profession and upholding high standards of behaviour by stamping out unacceptable behaviour of this kind will require erasure in a sexual misconduct case.

59.

Where the victim is a colleague rather than a patient, severe sanctions in such cases are generally necessary, in addition, to protect and uphold the dignity of workers in the profession and to protect their freedom to work without being molested. The victims are usually women.

60.

[…]

61.

[…] The days are gone when mainstream discourse was in any way split on the issue of sexual misconduct, particularly in the workplace. The mainstream in our society, reflected in our law, is now that there is virtual zero tolerance of such behaviour.

62.

In the criminal law, where personal mitigation counts for more than in this disciplinary jurisdiction, the law encourages judges to give offenders a second chance by imposing alternatives to immediate custody, such as a suspended sentence or a community penalty. Justice is tempered with mercy. That is more difficult in this jurisdiction because the nature of the sanction is not punitive but protective of the profession and the public. To justify the second chance, it has to be weighed not just against the risk that giving it may create more victims should he fail to take it. It also has to be weighed against the risk that public confidence in the profession will be undermined.”

The PSA submit that there is no reasonable justification for a “second chance”. It argues that the Committee wrongly focused at the sanction stage upon the sole incident that was found to be sexually motivated (1(g)(i-ii)). The Committee described the behaviour as “serious in contrast to the other conduct” and went on to state that it had [81-82]:

“… borne in mind that this relates to one finding in the context of one conversation. The Committee did not find that you were trying to engage in a sexual relationship with her or any of your female colleagues.

Furthermore, the Committee has borne in mind that there is no evidence of repetition of similar conduct, either before or since the incident”.

The PSA submits that the Committee drew an arbitrary distinction between conduct found to be sexual and the conduct found to be sexually motivated. They submit that the conduct needed to be viewed in the context of the overall sexual misconduct: allegation 1(g)(i-ii) was not isolated, but the most serious incident in a range of serious misconduct. The PSA submits that “to describe there having been ‘no repetition of similar conduct either before or since the incident was incorrect”, and the Committee failed to address the full extent of the misconduct.

The PSA submits that a determination regarding sanction must be approached having regard to the GDC’s Sanction Guidance as providing an “authoritative steer” (PSA v (1) GOC (2) Rose [2021] EWHC 2888 (Admin) [86]; PSA v (1) NMC (2) Jalloh [2023] EWHC 3331 (Admin) [23(7)]). As Collins J observed in (1) GMC (2) PSA v Bramhall [2021] EWHC (2019) (Admin) at [42], the aim of the guidance is to promote consistency and transparency of decisions so that any departure must be clearly reasoned:

“The discipline of fully addressing the application of the Sanctions Guidance to the facts, and clearly articulating reasons for any departure determined upon, is itself the surest route to a secure assessment of gravity of misconduct and hence of proportionality. Shortcuts must be resisted, particularly where they risk being – or, as importantly, being seen to be – unduly influenced by considerations of personal mitigation.”

In respect of erasure, the Committee identified “one finding that [the Registrant’s] conduct was sexually motivated”. The PSA submits that the Sanction Guidance does not distinguish between sexually motivated misconduct and sexual misconduct more broadly, it simply refers to “findings of a sexual nature” as a factor indicating erasure might be appropriate.

The PSA therefore submits that the Committee was wrong to limit its findings to sexually motivated behaviour in this respect. If the Committee had recognised the widespread findings of misconduct of a sexual nature and considered those, the PSA submit it would be strongly indicative of erasure being the correct sanction.

The PSA submit that the Committee placed excessive weight upon the Registrant’s reflections upon his actions.

At the impairment stage, the Committee found:

“insufficient depth of reflection of the impact of the incidents on all those involved and insufficient understanding of the consequences and implications of [his] behaviour on [his] colleagues”.

It noted that the Registrant continued to minimise some incidents and had:

“not fully expressed remorse for [his] actions and a confirmation of a change in [his] values in regard to professional behaviour and professional relationships”.

The Registrant’s reflections on his actions were accordingly very limited. Nevertheless, in considering the Registrant’s sanction, the Committee said it had:

“...borne in mind that you have reflected on your actions and you have engaged in targeted remediation. Taking all these factors into account, the Committee has concluded that whilst the behaviour is attitudinal, you have shown the ability to reflect and taken steps toward remediating your misconduct. The Committee is satisfied that the misconduct in this case was not fundamentally incompatible with remaining on the register.”

The PSA submits that the Committee should not have placed significant weight on these factors, which could not on any proper analysis outweigh the serious and widespread nature of the Registrant’s misconduct. The PSA argues that it was “wishful thinking” to suggest that any further insight might develop (see PSA v (1) NMC (2) Judge [2017] EWHC 817 (Admin) [40]). As discussed in Yeong v GMC [2009] EWHC 1923 (Admin) at [51-2], the PSA submit that it is well recognised that behaviour such as repeated sexual misconduct is harder than clinical failings to remedy.

In relation to the final ground, the PSA submit that the nature and seriousness of the misconduct, combined with minimal insight into attitudinal issues and the risk of repetition, meant that erasure was the only appropriate sanction in this case, and the sanction indicated by the Sanction Guidance.

The PSA submits that the factors engaged, which support this conclusion are:

“Serious departure(s) from the relevant professional standards;

The abuse of a position of trust or violation of the rights of patients, particularly if involving vulnerable persons;

Convictions or findings of a sexual nature, including involvement in any form of child pornography;

A persistent lack of insight into the seriousness of actions or their consequences.”

The PSA relied upon the statement in Bolton v Law Society [1994] 1 WLR 512 at [519B-E], that the reputation of the profession is more important than the fortune of any individual member and submits that:

“Widespread, repeated misconduct, primarily directed towards junior female colleagues, of a racist, sexist, and sexual nature is profoundly unacceptable, and fundamentally incompatible with the role of dentist. Such conduct seriously undermines the reputation of the profession and demands a strong declaration to uphold professional standards and the public interest. Severe sanctions are required for those who do not respect the dignity of their colleagues, particularly when their insight into their misconduct is limited. The reputation of the profession is more important than the fortunes of any individual member”.

The PSA therefore submits that, based on the above six grounds, the appeal should be allowed, and the Committee’s decision quashed.

The PSA submits that the court should:

In summary the GDC submits:

The GDC does not oppose the PSA’s submissions regarding Ground 1.

The GDC does not contest Ground 2. Although The Committee received legal advice and submissions on the meaning of sexual motivation it found that allegations 1(e), 1(n) and 1(p) were not sexually motivated, despite the clear inference which can be drawn from inherently sexual questions and comments.

In relation to Ground 3, the GDC submits that the allegations could have been framed in terms of harassment, as per section 26 of the 2010 Act, but that it was not necessary to do so applying the GDC’s own rules and/or to bring the full gravity of misconduct to the attention of the Committee. Thus, the absence of a specific charge of harassment does not explain the insufficient sanction and is not a serious procedural irregularity. The GDC does not accept that by failing to allege harassment, the “full gravity” of the situation was not before the Committee, or that it “went off on a fundamentally misconceived footing” (see Jozi).

At Stage 1, the Committee recognised the impact of the Registrant’s behaviour and found that the comments were “sexually intimidating” (in reference to the “rape eyes” comment), that the physical contact was inappropriate, that they made WA feel uncomfortable, and that the comments made were discriminatory towards women and black people. The GDC submits that WD gave clear evidence that in her view the Registrant’s comments amounted to sexual harassment, and said she was intimidated, stating “I believe any man that could say that he would pour acid on his own daughter is quite an intimidating person”.

At Stage 2, the remediation evidence on behalf of the Registrant included Continuing Professional Development (“CPD”) relating to sexual harassment, which was also covered in his reflective statement. The Registrant stated that:

“completing this course has been a transformative experience. It has helped me better appreciate how even seemingly humorous comments can be harmful, especially in hierarchical or mixed-gender teams…I sincerely apologise for any discomfort or offence that my words may have caused”.

The Committee noted the GDC’s submissions that emphasised “the serious nature of the misconduct, which was repeated over a long period of time, which involved an imbalance of power over female dental nurses” and which was fundamentally incompatible with practise.

In finding misconduct, the Committee found a breach of Paragraph 6.1.2 of the GDC Standards for the Dental Team, which stipulates that you must not “bully, harass, or unfairly discriminate” against colleagues, and Paragraph 6.6.1 that “you should make sure that all team members, including those not registered with the GDC have…a work environment that is not discriminatory”. The aggravating features identified by the Committee included the fact that the misconduct was repeated over a period of years.

The ongoing nature of the Registrant’s actions and their impact was clearly presented to the Committee and understood by the parties before the Committee. The GDC Sanctions Guidance deals expressly with sexual misconduct but there is no express mention made of the 2010 Act, or to harassment. Therefore, characterising misconduct as sexual harassment, or as a breach of the 2010 Act, does not put it into a different “bracket” for the purpose of the Sanctions Guidance. The question of the gravity of the actions remains a matter for assessment by the Committee.

The GDC observes that the PSA’s skeleton argument refers to the GDC’s Fitness to Practise: Guidance for the Practise Committees, which deals with harassment specifically. This updated guidance applies to hearings commencing after 5 January 2026.

The GDC acknowledges that the GDC is subject to the public sector equality duty (“PSED”) found in section 149 of the 2010 Act. The PSED requires the GDC to have due regard to the need to eliminate (inter alia) discrimination or harassment. At Stage 2, the legal advisor had in fact directed the Committee’s attention to the 2010 Act and the PSED, although Counsel for the Registrant had submitted that it might be of limited relevance, a view shared by the court in Shah v GMC [2023] EWHC 899, where it “did not think that the [2010 Act] was of particular assistance in regulatory proceedings”.

On appeal, the PSA relies on PSA v (1) HCPC (2) Yong [2021] EWHC 52 (Admin), which the GDC submits can be distinguished from the present facts. In that case, the Registrant was alleged to have behaved “in a harassing manner”. The committee in that case misunderstood what that meant and had focused on his intention in finding the allegations not proved. Griffith J noted that the committee’s attention was not drawn to section 149 or section 26 of the 2010 Act when reaching its decision on harassment, and that the factual findings, when properly understood, did amount to harassment. In the present case, the GDC points out that there was no specific allegation of “harassment”, and submits that it was not required, in all the circumstances, to convey the gravity of the misconduct. The Committee’s attention was in any event drawn to the PSED.

Whilst the GDC does not therefore accept the PSA’s criticism in Ground 3, it also submits that the absence of an allegation of harassment makes a minimal difference overall and does not alter the necessary answer to the question of sufficiency.

The GDC agrees that the Registrant’s misconduct was extensive and wide-ranging. It submits that after relatively extensive efforts to remediate, including a one-day course on medical ethics, the Committee described the Registrant’s insight as still only “partial”, and that he continued to lack understanding of the appropriate behaviour and professional boundaries. The Committee stated that the Registrant had an “insufficient understanding of the consequences and implications of [his] behaviour on [his] colleagues. The Committee has noted you have not fully expressed remorse for your actions”. The GDC submits that the Committee accepted the Registrant’s behaviour was “attitudinal” and found that the Registrant had shown an ability to reflect and remediate, but, when considering suspension or erasure, no mention was made of this factor. The Sanctions Guidance lists harmful deep-seated personality or professional attitudinal problems as relevant to whether erasure is appropriate (at paragraph 6.28).

Therefore, it was incumbent upon the Committee to calibrate the seriousness of the attitudinal issue identified, when determining sanction. The GDC agrees with the PSA that the Committee failed to do so, and therefore, fundamentally under-estimated the seriousness of the misconduct described.

In respect of Ground 5, the GDC adopts the submissions advanced by the PSA. It agrees that the Committee failed to have separate regard to statements evidencing racial discrimination given that having found the allegation proved, the Committee said it “show[ed] a prejudice towards black men”.

At Stage 2, the GDC submitted that the discriminatory comments, whether sexual or racist, had no place in a modern dental workforce. The Committee’s analysis, however, made no reference to the two racially discriminatory comments. At the impairment stage, there was a brief reference made to a comment “in connection with a male patient that was discriminatory in nature”, but no attempt was made to distinguish between sexual and racial discrimination, or the different and cumulative impact these comments would have on public confidence in the profession.

Thus, the GDC submits that the Committee failed to consider the impact of this finding on public confidence in the profession, as it was required to do, which was in the circumstances a serious omission. As the court observed in CHRE v (1) NMC (2) Grant [2011] EWHC 927 (Admin):

“It was essential, when deciding whether fitness to practise was impaired, not to lose sight of the need to protect the public and the need to declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession. The panel should consider not only whether the practitioner continued to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made.”

The GDC maintains that having proper regard to the overarching objective, the gravity of the misconduct, and the Registrant’s partial insight and ongoing risk, the Committee was wrong in concluding that the appropriate sanction was suspension.

The GDC supports the PSA’s submissions that the Committee’s determination should be quashed and invites the Court to substitute the sanction of erasure. If the Court considers an alternative, the matter, it submits, should be remitted to the Committee.

The GDC submits that if the appeal succeeds, no order as to costs should be made against the GDC, as per PSA v (1) GDC (2) Patel [2024] EWHC 243 (Admin), where I adopted the earlier analysis of Chamberlain J in PSA v (1) GMC (2) Hanson [2021] EWHC 1288 (Admin), that no costs should be made where there had been no active opposition to the appeal.

The GDC acknowledged that there were examples of cases where a different approach had been taken and drew my attention to the 50/50 split ordered against respondents in PSA v (1) GDC (2) Hussain [2019] EWHC 2640 (Admin), where the GDC conceded the appeal and Ms Hussain resisted and lost. Hussain can, it was submitted, be distinguished from the current case as the court identified the errors in the GDC’s preparation and presentation of the case before the committee. In contrast the Registrant in this case was referred to the PSA by the GDC, and the GDC should not, it argues, bear any costs consequences of exercising its statutory function in a responsible manner.

The Registrant’s overarching submissions is that since the Court is exercising a supervisory jurisdiction, this warrants restraint when considering the Committee’s factual findings, which support the conclusions it came to and are within the proper latitude that should be afforded to it as the decision maker.

The Registrant submits that the Committee did not find allegation 1(l) sexual, it instead drew a parallel with 1(b). He submits that WA said the remark made her feel uncomfortable, but she did not consider the remark itself sexual.

Whilst the PSA argue that the only reasonable inference is a sexual one citing paragraph 47 of GMC v Haris [2020] EWHC 2518 (Admin), the Registrant submits that the conclusion in that case turned on very different facts:

“In the present case it is in my judgement clear beyond argument that the intimate touching of Patients A and B was sexual and that answering a question as to the motivation of the toucher, the only available answer, is yes, the motivation must have been sexual. This is another way of saying the only reasonable inference from the facts is that the behaviour was sexual. This derives from;

a.

The fact that the touching was of the sexual organs

b.

The absence of a clinical justification

c.

The absence of any other plausible reason for the touching.”

The Registrant submits that the reasoning in GMC v Haris proceeds on the basis that Dr Haris’s motivation must have been sexual, drawing in part on the sexual character of the behaviour when assessed against the three factors identified, including sexual touching. He contends that it is therefore unclear how the reasoning in Haris assists in determining whether a remark about an individual’s appearance, where it is not alleged to have been made with sexual motivation, can nonetheless properly be characterised as being of a sexual nature.

The argument advanced was that Haris draws on section 78 of the Sexual Offences Act 2003 (“the 2003 Act”), in relation to whether an activity was sexual:

“78 ‘Sexual’

For the purposes of this Part …. touching or any other activity is sexual if a reasonable person would consider that—

(a)

whatever its circumstances or any person’s purpose in relation to it, it is because of its nature sexual, or

(b)

because of its nature it may be sexual and because of its circumstances or the purpose of any person in relation to it (or both) it is sexual.”

Adapting this to whether a comment is sexual, the Registrant submits that:

He submits that “the purpose was clearly not a sexual one”, stating that “the word here is ‘chest’…this is not sexualised language”.

Further, since the Court is concerned with the difference between an inappropriate remark and a sexually inappropriate remark, the Registrant submits that the distinction is relatively insignificant as a basis for demonstrating that the sanction imposed was wrong when the gravity of the other findings in the case are considered since:

“it is difficult to see how any mistaken finding in respect of this one particular could render the ultimate decision to suspend [the Registrant] insufficient to protect the public”.

The Registrant submits that the Committee properly considered and rejected the inference that the Registrant’s conduct was sexually motivated. Its initial reasoning was amplified somewhat at the misconduct stage by the conclusion that:

“Whilst some of these were of a sexual nature, it considered that these were made out of an attempt by you to assert your authority and were done in a provocative manner to get a reaction out of the other person. The Committee heard from some of the witnesses that you were known to make provocative and inappropriate comments which made them feel uncomfortable.”

This was then repeated at the sanction stage:

“The Committee has determined that, whilst some of your comments and behaviour were of a sexual nature, they were made out of an attempt by you to assert your authority and were done in a provocative manner to get a reaction out of the other person”.

Whilst the Registrant concedes that it is “obvious the comments in question are open to an inference [that] they were sexually motivated” he submits that the PSA overstates the position in asserting that this was the only conclusion open to the Committee. He argues that this was a classic example of findings akin to jury questions “about which people may reasonably disagree”. Thus, the Committee’s analysis fell well within the Committee’s margin of appreciation.

On this last point, the Registrant observes that the legal adviser gave advice to the Committee in the following terms:

“From the case of Harris v GMC, High Court, Court of Appeal, the advice comes that when considering sexual motivation, you should make a deduction from all the facts and circumstances of the case and looking at the material in the round. There is no plausible alternative explanation why a person engaged in conduct or actions which were of a sexual nature. The tribunal is entitled to conclude the motivation was sexual. That is paraphrasing from the judgment really. It is worth bearing in mind that the case of Harris involves factors of sexual touching which is perhaps not quite so close to comments but, nevertheless, there is useful guidance there.

I would mention also the case of Arunkalaivanan v General Medical Council [2014] which asserts it is important not to equate inappropriate conduct with sexually motivated conduct. You should consider whether there could be any other explanation for inappropriate conduct. Mr Brassington in his submissions mentioned the case of Soni which does deal also with a similar point of the necessity to consider alternative explanations and the exclusion of them if you are to draw an inference on particular motivation.”

Mr Brassington, counsel for the Registrant at the hearing before the Committee, made submissions as to the possible motivation behind the Registrant’s conduct, in his closing:

“This is also a man who is described as trying to get the rise out of people. He is a man who is described as saying random things which can be controversial and offensive. There is an equal inference to be drawn from all of this which is that he was simply trying to be provocative and controversial.”

It was submitted in the appeal before me that “there was evidence to suggest the Registrant did say things to shock, in keeping with the Committee’s analysis.” For example, WA was questioned and gave answers as follows:

“Q: You have described Dr. Rahman variously in these terms, that he is the sort of person that wants to get the rise out of people.

A. Yes.

Q. Correct?

A. Yes.

Q. That he will say random things out of the blue, seemingly to get the rise out of others, correct?

A. Yes.

Q. But you did not find it offensive, did you?

A. Not originally, not at the beginning.”

Moreover, the GDC’s counsel questioned the Registrant in a similar vein at the hearing. Whilst it was put to him that the various sexual comments were made with a view to pursuing a sexual relationship, the alternative proposition suggested was that he acted out of a desire to shock or generate a reaction:

“Q. I think it was Witness C [in fact Witness A] who described you as liking to get a rise out of your colleagues. Was all this talk about seeing how far you could push the boundaries with them?

…

Q. You are not sure whether you liked to get a rise out of people? You like to provoke.

…

“Q. These comments about having a ranking system, speaking about who you would shag, or sleep with, were entirely inappropriate and suggestive. Was it that they were designed to shock if nothing more?”

Racism and homophobia were explored similarly:

“Q: You were trying to be extreme and provocative yourself in saying such a thing to Person D

…

Q. It is about what you said about a patient who was black, it was in that context. Was it you trying to shock?”

...

“Q… you did in fact say, “I hate gays, but I like you”. Whether that was done in an attempt at being humours or provocative, I do not know but the phrase you used was, “I hate gays, but I like you”.”

It was argued that against a background of questioning suggesting that the Registrant may, as an alternative, have made remarks out of desire to shock or “get a rise out of” colleagues, this was a possible explanation or motivation for his remarks which the Committee was entitled to accept.

The Registrant finally submits under this ground that the Committee was bound to consider explanations, other than sexual motivation. He submits that this is not a case such as Haris, where there was sexual touching and where such conduct, if proved, could lead to no other interpretation. He argues that the Committee was entitled to come to the view it reached on the issue and the “PSA cannot identify any legal errors which can justifying interfering with that judgment”.

The Registrant submits that it was not necessary for his conduct to be charged as sexual harassment. The gravity of the Registrant’s misconduct towards female staff was reflected in the findings made in respect of allegations 1(d), 1(e), 1(f), 1(g), 1(h), 1(j), 1(l), 1(m), 1(n), and 1(p), such that limited further instances “would hardly have impacted on the overall assessment of seriousness”.

The Registrant also relied on his reflections on the issue of sexual harassment and pointed out that the Committee’s legal advisor drew attention to the 2010 Act, and the duty to eliminate harassment:

“Where you depart materially from guidance, the courts have held there is an obligation to explain your reasons carefully. There are particular sections within the sanctions guidance that you may find of relevance in regard to abuse of privileged position of registered professionals in paragraphs 52 and 53. There is also some consideration of another relevant element of sexual misconduct in paragraphs 73 and 75. But the whole of the guidance is commended to you for your consideration.

In considering the question of impairment more generally, I think it is right also to mention the relevance of the Equality Act 2010 in light of the allegations here involving questions of treatment of others and allegations of discrimination and sexual comments. The regulator, as a whole, is subject to a public sector equality duty, under section 149 of the Act to exercise its functions, having due regard to the needs to eliminate discrimination, harassment, victimisation and any other conduct prohibited under the Act, which extends to such as the General Dental Council.”

In addition, it is submitted that the “Committee plainly did turn their mind to the degrading and offensive environment created by” the Registrant, and stated in relation to the impairment stage:

“the Committee considered that the comments you made to your female colleagues, which were found to be variously inappropriate and/or, sexual and/or discriminatory, and lacking in kindness and compassion as set out in its facts determination, were serious and amounted to a serious falling short of professional standards” [pg 70, para 53]

The Committee expressly considered certain sections of Standards for the Dental Team, paragraph 6.1.2 was engaged, including:

“6.1.2.

You must treat colleagues fairly and with respect in all situations and all forms of interaction and communication. You must not bully, harass, or unfairly discriminate against them.

…

6.6.1

You should make sure that all team members, including those not registered with the GDC, have … a work environment that is not discriminatory.”

In respect of current impairment, the Committee commented:

“It has had regard to the serious nature of the findings which include making comments that are sexual in nature and in particular a finding that the comments you made to your female colleague in or around October to November 2022 was sexually motivated. In the Committee’s judgement, this was an abuse of your position of trust as one of the senior members of the dental team. You also made comments to female dental colleagues and in connection with a male patient that were discriminatory in nature. The evidence from some of the dental nurses is that they found these comments offensive. The Committee considers that such comments are completely inappropriate and have no place in a dental professional environment”.

Further at the sanction stage, the Committee noted “the abuse of position of trust, particularly in relation to female dental colleagues”. The Registrant therefore submits that the seriousness of the conduct was properly put before the Committee such that, “to attach the label of ‘harassment’ to this conduct would not alter the fundamental nature of the conduct itself”. As per Shah at [88-90], the 2010 Act is relevant not least as a measure of behaviour expected in society, but:

“one must be careful not to overstate the relevance of the 2010 Act. It is not a trump card leading to an automatic finding of serious misconduct, still less automatic erasure.

The provisions of the 2010 Act create statutory causes of action in tort. The conduct of a doctor in a particular case could be just as much deplorable sexual harassment if the causes of action in tort had never been enacted. The fact that a legal label fits the doctor’s conduct does not change what the doctor did and did not do. Many wrongs in our society contravene more than one law. The appetite for adding to the list of legal labels to describe wrongs is very strong but it is still the same conduct being judged.

… The tribunal does not apply the wording of section 26 of the Act to determine the issue of impairment or the appropriate sanction. The doctor’s conduct is judged according to the regime laid down in the Medical Act 1983, the relevant Fitness to Practise Rules (which were not in the authorities’ bundle) and the Sanctions Guidance.”

The Registrant argues accordingly that the use of terminology derived from tort law would not have advanced the analysis in this case, and there is no proper basis for suggesting that the allegation was undercharged. The Committee was clearly cognisant of the seriousness of the conduct. Whilst the PSA observes that, had sexual harassment been charged, the Committee would have recognised such conduct as capable of amounting to a criminal offence, it cannot sensibly be contended, it is argued, that a disciplinary committee should determine whether a criminal offence had been committed.

The Registrant submits that the PSA’s contention that the Committee failed to recognise that the Registrant had a “harmful deep-seated personality or professional attitudinal problems”, which was a factor in the guidance indicating that erasure may be the appropriate order, is flawed for two reasons.

Page 74, [83] of the Committee’s ruling states:

“The Committee has borne in mind that you have reflected on your actions and you have engaged in targeted remediation. Taking all these factors into account, the Committee has concluded that whilst the behaviour is attitudinal, you have shown the ability to reflect and taken steps toward remediating your misconduct.”

The Committee, he submits, made a multi-factorial decision, which illustrates that it was well aware of this factor in the guidance. It concluded, as it was entitled to, that the Registrant’s ability to reflect and remediate meant he did not fall within the category of having a deep-seated attitudinal problem; that is to say one that was so entrenched that it could be changed (see Yeong v GMC [2009] EWHC 1923 (Admin), which discusses the difficulty in remediating attitudinal issues).

He submits that read together, Bawa Garba, Shah and Gilbert establish that, when exercising its supervisory jurisdiction, an appellate court should be slow to interfere with evaluative judgments made by a disciplinary tribunal. It is not necessary for a practitioner to demonstrate complete or perfected insight to avoid a finding of a “deep seated attitudinal problem”. What is required is a demonstrated capacity to learn from errors and remediate conduct, rather than the presence of full insight at the time of the hearing.

Whilst the Registrant accepts that the misconduct in this case was serious and repeated he points out that there is no evidence of any repetition in the intervening 2 ½ years since the initial referral. There was no suggestion before the Committee that the Registrant was unable to stop, notwithstanding the referral. The Registrant had undertaken relevant and targeted CPD on relevant issues, such as harassment, and had engaged with the gravity of the misconduct; consistent with the Committee’s decision that he was capable of growth and development.

The Registrant submits that the PSA’s criticism that, inter alia, “the fact at sanction the Committee only focused on the one instance of the sexually motivated misconduct”, is unjustified for four reasons.

The Registrant therefore submits that the Committee was entitled to consider there had been no repetition of sexually motivated behaviour, which was the most serious finding, and did not ignore other findings of sexually inappropriate conduct.

He argues ultimately that the assessment of remediation is pre-eminently a matter for the tribunal, as affirmed in Bawa Garba, Shah and Gilbert, and that, in the exercise of a supervisory jurisdiction, there is no reasonable basis for disturbing its decision. As Shah makes clear, it would be wrong to expect a sudden or complete transformation of attitude immediately following adverse factual findings. A Committee must be entitled to allow a professional who has demonstrated a capacity to learn the time necessary to reflect meaningfully on those findings.

Before turning to my conclusions, I record that I have considered all of the materials before the Court with care. This has included not only the Committee’s determination and the written submissions of the parties, but also the relevant extracts from the evidence and transcripts of the proceedings before the Committee and the positive testimonials in the Registrant’s favour. I have had well in mind the advantage enjoyed by the Committee in seeing and hearing the witnesses, and I have approached its findings with appropriate respect. I have had the assistance of extensive written and oral submissions from counsel which were comprehensive and of high quality on all sides.

I have also taken into account the significance of the outcome for the Registrant. Findings of this nature, and the question of sanction, have the most serious consequences for his professional standing and livelihood. It is therefore incumbent upon this Court to ensure that any interference with the Committee’s decision is justified by clear error of principle or outcome.

It is against that background and applying the proper degree of restraint appropriate to an appeal of this kind, that I have reached the conclusions set out below.

Drawing the threads together, I am satisfied that the Committee fell into error in its approach to sanction. The difficulty does not lie in any single finding, but in the combined effect of a number of shortcomings which, taken together, led the Committee materially to underestimate the seriousness of the Registrant’s misconduct and its implications for public protection and the public interest.

In particular, the Committee failed adequately to grapple with the cumulative gravity of the conduct it had found proved. That conduct was neither isolated nor peripheral. It consisted of repeated inappropriate, sexualised and discriminatory behaviour over a sustained period, principally towards junior female colleagues. It also included racist remarks of a particularly disturbing character and conduct towards patients which fell short of the standards expected of a registered practitioner. As Mr Standing submitted, on behalf of the PSA, this was a pattern of behaviour, not a misjudgement in specific circumstances, and was indicative of acceptable attitudes towards women and other races.

Notwithstanding its findings, the Committee’s reasoning at the sanction stage did not sufficiently reflect the breadth and persistence of the misconduct. It drew distinctions, particularly between conduct which was sexually motivated and that which was not, which risked minimising the overall seriousness of the case. Further, although the Committee recognised that the behaviour was “attitudinal”, it did not adequately evaluate the nature and significance of that attitudinal failing when determining the appropriate sanction.

In addition, the Committee placed weight on evidence of insight and remediation which, on its own findings, was limited. It had earlier concluded that the Registrant’s insight was only partial, that his understanding of the impact of his behaviour was incomplete, and that a risk of repetition remained. In those circumstances, the weight accorded to remediation at the sanction stage was not properly calibrated to those findings.

A central difficulty with the Committee’s determination lies in the manner in which it approached the allegations. In my judgment, the Committee considered the individual particulars in a largely compartmentalised way, rather than evaluating the Registrant’s conduct as a course of behaviour over time. That approach materially affected its assessment both of the sexual character of the conduct and of its overall seriousness. Setting the material conduct out in sequence reveals that it was escalating, evolving from questions of a sexual and intrusive nature to statements of a general nature which then became specific to individuals and led finally to unwanted invitations for physical contact and the act of touching.

The misconduct found proved did not consist of isolated or coincidental remarks. It was a pattern of repeated conduct, in which the Registrant persistently engaged female staff members in conversations of a sexualised nature, made explicit or suggestive comments, and, on at least one occasion, engaged in conduct which was found to be sexually motivated. That pattern was accompanied by discriminatory and offensive remarks and took place in a context of a professional hierarchy in which he was the senior individual.

In those circumstances, the proper question for the Committee was not simply whether each individual remark, viewed in isolation, could be characterised as sexual or sexually motivated. Rather, the Committee was required to assess the nature of the Registrant’s conduct in the round, including the obvious inference to be drawn from repeated, unsolicited sexualised interactions with junior female colleagues.

By approaching the allegations in isolation, the Committee lost sight of that broader context. In particular, its reasoning demonstrates a tendency to treat individual incidents as self-contained, giving rise to distinctions, such as between sexual and non-sexual remarks, or between sexually motivated and non-sexually motivated conduct, which failed adequately to reflect the cumulative reality of what had occurred. The result was that the Committee reached conclusions in relation to the sexual nature and motivation of certain interactions which were, in my judgment, unsound.

It follows that the errors identified are not merely discrete mistakes in respect of individual particulars but are symptomatic of a broader failure to assess the evidence holistically. That failure materially undermined the Committee’s evaluation of seriousness and, ultimately, its decision on sanction. I make the following findings in relation to the individual grounds.

I accept this ground. The Committee found that the Registrant described a female patient as having “a pretty face but such a small chest” but concluded that there was nothing to suggest that the comment was sexual in nature. In my judgment, that conclusion cannot be sustained.

A remark directed to a woman’s chest, made in a context wholly unconnected with any clinical purpose, is inherently capable of bearing a sexual meaning. When viewed alongside the wider pattern of conduct, namely, repeated sexualised remarks towards female colleagues, the only reasonable inference was that the comment formed part of that same pattern of sexualised behaviour, and was intended to, and was a comment about the size of a woman’s breasts. The Committee’s conclusion to the contrary reflects its failure to consider the remark in its proper context.

I accept this ground. The Committee found that a number of plainly sexualised interactions, including unsolicited questioning of female colleagues about their sex lives, remarks about sending explicit images, and comments ranking colleagues in sexual terms, were not sexually motivated. It reached that conclusion on the basis that it could not exclude the possibility that the conduct was an attempt to assert authority or provoke a reaction.

In my judgment, that reasoning is flawed. While it is correct that sexual motivation is a matter of inference, the Committee was required to draw that inference from the totality of the evidence. The conduct in question consisted of repeated, unsolicited and explicitly sexual interactions which had no conceivable professional justification. In those circumstances, the inference of sexual motivation was a strong one and the only reasonable one in the circumstances. It was overwhelming likely, as Ms Hearnden submitted on behalf of the GDC, that the behaviour was sexually gratifying for the Registrant which was why his interactions with female staff involved comments which were sexual.

The Committee’s reliance on an alternative explanation of provoking behaviour to “get a rise” was, in this context, insufficient. The two are not mutually exclusive, and the suggestion that such conduct was merely an assertion of authority fails to engage with its inherently sexual character. Once again, the error stems from treating the incidents in isolation rather than recognising the pattern of conduct as a whole.

I do not accept this ground. The Committee had before it extensive allegations which captured the substance and gravity of the Registrant’s conduct, including findings of repeated sexualised and discriminatory behaviour, and breaches of the relevant professional standards prohibiting harassment. The evidence of the impact of that conduct on colleagues, and the nature of the working environment which it created, was clearly before the Committee. In those circumstances, the absence of a specific formulation of “harassment” by reference to statutory terminology did not deprive the Committee of the ability to assess the seriousness of the case, nor did it lead to any material procedural unfairness or misdirection. The nature of the working environment created by the Registrant was fully explored. The shortcomings in the determination arise, not from any failure in the framing of the allegations, but from the Committee’s subsequent evaluation of their gravity and the appropriate sanction. It would plainly have been possible for a harassment allegation to have been made, and on one view that may even have been desirable, but the question of which charges to bring was a judgment in respect of which the GDC is entitled to a significant degree of latitude.

I accept this ground. The Committee expressly described the Registrant’s behaviour as “attitudinal” but did not adequately analyse the nature or seriousness of that finding when determining sanction. In particular, it failed to engage with whether the conduct evidenced a deep-seated attitudinal problem of the kind identified in the Sanctions Guidance as pointing towards erasure.

Given the persistence and nature of the conduct, and the Committee’s own findings as to limited insight and continuing risk, that was a material omission.

I accept this ground. The Committee’s evaluation of sanction was undermined by its earlier errors but also contained discrete deficiencies. In particular, it failed properly to account for the cumulative seriousness of the misconduct, including its discriminatory aspects, and drew an artificial distinction between sexually motivated and other sexual conduct which had no proper basis in the Sanctions Guidance.

It also placed undue weight on limited evidence of remediation and developing insight, notwithstanding its own findings that insight was incomplete and that a risk of repetition remained.

It is not necessary, given the view I have reached as to the appropriate disposal, to decide whether erasure was the only appropriate outcome. However, I am satisfied that the sanction imposed fell outside the range of reasonable responses open to the Committee, for the reasons given above.

Taken cumulatively, these matters lead me to conclude that the sanction imposed, a 6-month period of suspension with review, was not sufficient to meet the overarching objective of protecting the public, maintaining confidence in the profession, and upholding proper professional standards. In those circumstances, the appeal must be allowed.

As to disposal, I have considered whether it would be appropriate for this Court to substitute the sanction of erasure. However, the determination as to sanction in a case of this kind is a multifactorial evaluative exercise which is ordinarily best conducted by a specialist tribunal. In light of the errors identified, and bearing in mind the need for that evaluative judgment to be undertaken on a proper footing, I am satisfied that the appropriate course is to remit the matter to a differently constituted Committee for reconsideration of sanction.

On remission, the Committee will be required to reconsider the question of sanction in light of this judgment, proceeding on the basis of the findings made, save insofar as any are affected by the conclusions I have reached. It will be a matter for the Committee to determine what sanction is necessary to satisfy the statutory objective, having proper regard to the gravity of the misconduct as a whole, the nature of any attitudinal concerns, and the evidence as to insight, remediation and risk of repetition.

I turn finally to the question of costs. The GDC has not opposed the appeal and, indeed, referred the matter to the PSA in the exercise of its statutory functions. In those circumstances, the GDC is properly to be characterised as having acted in a neutral, quasi-judicial capacity. In line with the approach adopted in Hanson and subsequently applied in Patel, it would not be appropriate to make an adverse cost order against a regulator in such circumstances.

The errors which have led to the allowing of the appeal lie in the reasoning of the Committee, rather than in the manner in which the GDC presented the case or conducted the proceedings. In those circumstances, I make no order as to costs against the First Respondent.

So far as the Registrant is concerned, I will hear submissions on costs if necessary.