Dr Manori Balachandra v NHS England

This is an appeal by Dr Balachandra against the decision of the Performers List Decision Panel (the "PLDP" or “the panel”) dated 18 March 2025. The decision made was to refuse her application for inclusion in the Dental Performers List (DPL) by reference to regulation 7 (2) (b) (the “suitability grounds)” and (g) (the “efficiency grounds” of the National Health Service (Performers List) (England) Regulations 2013 (“the regulations”).

The Respondent has a statutory responsibility to regulate primary practitioners included in the performers list: see Regulation 3(1) of the Regulations. In order to perform primary care services under the NHS in England, registered dental practitioners are required to be named on the DPL maintained by the Respondent – see Regulation 3(1)(b).

The Appellant, Dr Balachandra, was awarded a Bachelor of Dental Surgery (BD) degree from King’s College School in London in 2000. On 31 July 2000 she was included in the Dental Register maintained by the General Dental Council (GDC).She applied for, and was granted, inclusion to the DPL in 2000. She thereafter worked at various dental practices across the region before setting up her own predominantly NHS dental practice in Fareham. She initially practised alone, but over time she expanded the business. By 2023, the practice had grown to employ 3 to 4 other dentists, 3 to 4 full-time dental assistants, a practice manager, and an administrative clerk. The practice primarily provided NHS dental care. By the time of the events which we are concerned around 80% of the work undertaken was NHS related, amounting to approximately 21,000 Units of Dental Activity (UDAs) per year, and a turnover of approximately £543,000 annually.

The main events are as follows:

Although it is agreed that we are involved in a redetermination, the Appellant places particular emphasis on the reasons given by the PLDP so we set these out. The Chair said that the panel:

“.. heard how claims for UDAs that were not justified were submitted in your name. How, when it was discovered, you fabricated handwritten letters appearing to ask for the claims to be deleted when no such requests were received by NHSBSA (i.e. the NHS Business Services Authority). It also heard how you amended clinical records with non-contemporaneous notes to justify the false letters.

The panel deemed these actions undertaken by yourself, and admitted to during the GDC hearing, were dishonest and premeditated. It concluded that the attempt to claim money for NHS work not undertaken, and then to attempt to cover it up with fraudulent correspondence makes you not suitable to be included on the dental performers list. The National Health Service (Performers Lists) (England) Regulations 2013”.

The decision then went on to set out Regulations 7 (2) (a) (ii) and (g) but without further reasoning.

The minutes of the meeting (C148) shed some light on the Panel’s consideration and included that:

Under the heading “Reason for Decision” in the minutes it was recorded:

“the Panel deemed that previous actions undertaken by the practitioner, and admitted to during the GDC hearing, were dishonest and premeditated which question the practitioner’s probity and therefore, the practitioner is not suitable to be included in the…list.

Additionally, the panel “deduced that readmittance to the list would be prejudicial to the efficiency of services, given the volume of previous cases, and resources used to remediate those concerns and any subsequent concerns that may arise.”

The main points are that:

We had received and read in advance of the hearing a paginated and indexed bundles consisting of 501 pages (pdf) which, amongst other evidence, included Dr Balachandra’s statement in this appeal dated 2 July 2025. It also included the Respondent’s skeleton argument and case law/authorities on which it relied. The day prior to the hearing the Appellant submitted the skeleton argument from Mr Butler, together with further authorities, the latter being contained in an additional bundle (69 pages pdf).

At the outset of the hearing the judge outlined the legal process involved in an appeal under regulation 17. This included that:

In the interests of fairness and transparency, the judge also explained to the parties that the Tribunal was aware of two sets of NHS policy guidance which had not been formally included in the bundles, but which might be relevant to the parties’ submissions regarding the distinction, if any, to be drawn between “fitness to practice” and “fitness for purpose”.

The Judge also explained that, from the panel’s perspective, the key issue in this appeal was that of the Appellant’s insight and attitude. She asked whether the arguments advanced in the Appellant’s skeleton dated 6 October 2025 regarding abuse of process, duplicative proceedings, res judicata and issue estoppel etc. were pursued. Mr Butler said that they were not: he confirmed that a line could be put through them as they did not require consideration.

It had been intended that we would hear oral evidence on oath from the Respondent’s witnesses:

We heard oral evidence from Dr Balachandra who adopted her statement dated 2 July 2025 and answered questions. We do not intend to set out herein all the oral evidence given but will refer to parts of it when making our findings below.

The key provisions of The National Health Service (Performers Lists) (England) Regulations 2013 are as follows:

“Decisions and grounds for refusal

7.

—

NHS England—

As we have said a large number of cases were placed before us. We considered them all but we need not list them. Firstly, whilst decisions of the First-tier Tribunal are always of interest, and may be persuasive, they are not binding. Secondly, we had been provided with a number of authorities regarding the legal arguments that were expressly abandoned by the Appellant at the outset of the hearing. In the light of Dr Balachandra’s oral evidence, the judge asked the parties to provide and address relevant authorities since it had become apparent in cross examination that Dr Balachandra’s case was that she maintained (at least in part) her original defence.

We have consideredthe decision in Professional Standards Authority for Health and Social Care v NMC and Shah [2022] EWHC 1215 (Admin) in which Lang J said at [57].

“The parties referred me to a summary of the approach to be taken to a “rejected defence” and lack of insight in Professional Standards Authority for Health and Social Care v Nursing and Midwifery Council and Jalloh [2023] EWHC 3331 (Admin), per Morris J. at [24]:

(1)

Insight is concerned with future risk of repetition. To this extent, it is to be distinguished from remorse for the past conduct.

(2)

Denial of misconduct is not a reason to increase sanction.

(3)

It is wrong to equate maintenance of innocence with lack of insight. Denial of misconduct is not an absolute bar to a finding of insight. Admitting misconduct is not a condition precedent to establishing that the registrant understands the gravity of the offending and is unlikely to repeat it.

(4)

However attitude to the underlying allegation is properly to be taken into account when weighing up insight. Where the registrant continues to deny impropriety, that makes it more difficult for him to demonstrate insight. The underlying importance of insight and its relationship with denial of misconduct was usefully analysed by Andrew Baker J in Khetyar (at §49) as follows:

"Of course, no sanction was to be imposed on him for his denials as such; however, insight requires that motivations and triggers be identified and understood, and if that is possible at all without there first being an acceptance that what happened did happen it will be very rare, and any assessment of ongoing risk must play close attention to the doctor's current understanding of and attitude towards what he has done."

(5)

The assessment of the extent of insight is a matter for the tribunal, weighing all the evidence and having heard the registrant. The Court should be slow to interfere.”

We also considered Sawati v GMC [2022] EWHC 283 (Admin) in which Mrs Justice Rice Collins considered, amongst other matters, an appeal against sanction. In essence, Dr Sawati’s appeal against erasure centred on the argument that the fact she had maintained her honesty in her defences at the fact-finding stage was unfairly held against her at the sanction stage.

Dr Balachandra brings this appeal under regulation 17 (2) (a). Regulation 17 (1) provides that the appeal is by way of redetermination. Regulation 17(4) also provides that on appeal the First-tier Tribunal may make any decision which the PLDP could have made.

In this appeal the “matter in question” under regulation 7 (3) are the findings made by the PCC - to which we will return.

The grounds of appeal are to the overall effect that the analysis of the PLDP regarding the Appellant’s conduct was wrong, and also that PCC’s view that the Appellant is “fit to practice” should be determinative of the outcome in this appeal.

We are required to make a de novo (i.e. fresh) decision, standing in the shoes of the PLDP. This may be informed by new information or material that was not available to/considered by the PLDP. The redetermination of the appeal includes consideration of the evidence provided by both sides in this appeal, the oral evidence and submissions before us. We have considered all the material before us. If we do not refer to any particular point in the evidence or submissions it should not be assumed that we have not considered the evidence or points made. We focus on those matters which we consider are of more importance in our redetermination.

Given the grounds of appeal, the views expressed in Dr Balachandra’s witness statement, and the points taken in the Appellant’s skeleton argument, it is appropriate to draw out the similarities and differences between the two statutory bodies. In our view:

As we have said, the Respondent is the body responsible for admission to, or removal from, the list of primary care performers it maintains and publishes, and has regulatory oversight of the performers of primary care services whose names are included in the list. In short, a decision to include a practitioner’s name on the relevant list objectively conveys to the public an assurance that NHS England considers that she is suitable to be included in the DPL. In our view the outcome of an application for inclusion in the DPL (following removal by operation of law because of the substantive decision by the professional regulator to impose suspension), is not properly to be regarded as governed by the view of the professional regulatory body that the practitioner is “fit to practise”. If parliament had considered that this were so it would not have been necessary to enact regulation 7 (amongst others). The issues of suitability and/or efficiency have to be viewed in the context of the NHS Regulations and applying regulation 7 (3) which, amongst other matters, requires that the Respondent considers the views of regulator.

We accept the decisions of the PCC panels who, at different times, found facts and assessed the issues of fitness to practice and/or sanction are highly relevant and require consideration.

The contents of PLDP decision letter have been closely dissected, it being contended that the panel’s analysis was wrong and their decision was based on findings of dishonesty which had not been proved. We are engaged in a redetermination so considering rival arguments as to how matters were phrased etc. is a sterile exercise. However, we do consider it appropriate to set out the findings made by the PCC at various stages in some detail.

In summary: The un-appealed charges before the PCC on 1-2 May 2024 were that:

When considering sanction in the un-appealed charges the PCC summarised the original PCC’s findings of fact.

“Charge 18

In a Clinical Adviser’s report, dated 19 June 2017, the Clinical Adviser deemed claims for NHS treatment submitted electronically by you to be inappropriate (or at least raised concerns). You then fabricated handwritten letters (“the handwritten letters”) which indicated that you had previously sent written requests to NHSBSA to delete claims referred to by the Clinical Adviser in their report. The letters were not genuine and no requests for deletion were ever made by you, and they were retrospectively created by you as a response to the concerns raised by the Clinical Adviser.”

Charge 19:

“You then caused retrospective entries to be made to the records of three patients which contained non-contemporaneous and inaccurate modifications to justify the letters of deletion.”

Charge 20:

“You then caused or permitted the handwritten letters to be sent to NHS England in 2018 and to the GDC in 2019.”

Charge 21:

The conduct set out above was both misleading and dishonest (in that your intention was to mislead).

The PCC in May 2024 noted that the original PCC found that the matters proved re charges 12, 13 and 14 did not reach the threshold for a finding of misconduct. It went on to deal with the matters proved under charges 18 -21. It said:

The PCC on 2 May 2024 received in evidence a number of documents including a statement from Dr Balachandra dated 26 April 2024 and other evidence such as testimonials and evidence of courses attended. There is no indication in the determination that Dr Balachandra gave oral evidence. The determination only notes the submissions made by both counsel. This included that Mr Butler (who has represented Dr Balachandra throughout) submitted that Dr Balachandra “had continued practising for many years since the letters were sent in June 2017, without any other concerns being raised” and that he “submitted that the same could be said of permitting retrospective entries to be made in electronic records which contained inaccurate information as to the need to withdraw/delete claims.” The determination states that Mr Butler also submitted that Dr Balachandra “admitted changing electronic records from which there was no harm to patients as they reflected the original documents; and that (she) had sent documentation to two bodies who had requested them.” (see C102 at paras 24 and 25).

In its decision on sanction on 2 May 2024 the PCC said this:

“33…The Committee noted that the misconduct arose as a result of a complaint which led to your UDA billing being assessed. After the matter was assessed by the Clinical Adviser, issues were raised regarding aspects of your clinical care and billing. The Committee noted that there are no adverse findings in relation to clinical care at this stage of this hearing and there are no findings that you were dishonest in your billing, albeit some errors were highlighted.

34.

Against that context, you had fabricated some letters in response to concerns raised by the Clinical Adviser. This was to give the impression that you had asked NHSBSA to delete several incorrectly made claims prior to the Clinical Adviser having raised the concerns. It has not been made clear why you decided to fabricate those letters, but the original PCC found that the letters were created when no such request had been made.

35.

In order to support the letters, the original PCC found that you altered the clinical records of three patients to reflect that you had requested the deletion of the incorrectly made UDA claims, when you knew this was not the case. It was unsurprising that NHS England and the GDC requested copies of these letters during their own investigations, and you supplied them to both parties despite knowing that the requests for deletion had not been made and that you had created the letters to support the dishonest assertion that you had done so. The Committee noted that, at the time that NHS England and the GDC had requested the letters, you had two options; to either tell the truth about the letters or to provide them. You chose to perpetuate your dishonest conduct and provided the letters. It is this misconduct that the Committee must consider in its decision on sanction.”

(our underlining)

The PCC considered the following to be aggravating features: persistent dishonesty; premeditated misconduct, in the alteration of the clinical records; misconduct sustained or repeated over a period of time; attempts to cover up wrongdoing; personal gain, albeit not financial; and breach of trust. We noted the PCC’s detailed analysis of these features which included:

“37.

The Committee considered the dishonesty in this case to be persistent in that you created the letters some time after 19 June 2017. You then changed the clinical records. In 2018, you provided copies of those to NHS England. Then in 2019, you had provided copies to the GDC. The Committee was satisfied that this must consist of a number of incidents over a significant period.

38.

In relation to Mr Butler’s submission that your conduct was a single incident, the Committee concluded that this was not the case; it considered that the dishonesty occurred on a number of occasions to include writing the letters, amending the patient records, and subsequently providing the letters to both parties. The Committee accepted, however, that it was essentially one course of conduct, with all elements relating to the original attempt to provide an answer to the queries raised by the Clinical Adviser. Ironically, the original PCC found the discrepancies in the billing to be mistakes and not dishonest and thus there was no need for you to have ever gone down this path.

39.

Although there is no evidence of financial gain, you had created the letters in an attempt to mislead the recipients in order to support your assertion that you had requested deletion of claims, when you knew you had not. The Committee was satisfied that this was an example of personal and/or professional gain, as in doing so you would have been “covering up” for the incorrectly made claims. The Committee considered the retrospective amendments to the clinical records of Patient 2, Patient 5, and Patient 11 to be a serious departure from the relevant standards. For a registrant to access clinical records and make amendments that are known not to be true is indicative of an attitudinal issue. In respect of the letters, the Committee also concluded that you had a choice regarding whether or not to provide the letters to NHS England and the GDC but had decided to send them, knowing them to contain inaccurate information. It concluded that this also raises concerns regarding an attitudinal issue which would undoubtedly affect the trust that members of the public would have in you as a professional and in the GDC as your regulator.

41.

The Committee noted that you acted dishonestly in creating the letters, changing the records, and then, when your conduct was being investigated, you continued along the same path by providing information to the GDC you knew was inaccurate and untrue. When considering whether or not you have remedied your dishonesty, the Committee referred to your statement. It took into account that you have changed systems, thereby ensuring that patient clinical records cannot be amended manually without an audit trail. However, without directly addressing the dishonesty that led you to have amended the records, the Committee considered that whilst this goes some way to prevent future recurrences, it did not negate the risk that you could act dishonestly again – only that it would be harder for you to cover up any dishonest conduct. In the absence of sufficient evidence of insight into your dishonesty, including why you behaved as you did, the Committee could not be satisfied that the risk of repetition of you behaving dishonestly has been sufficiently reduced.

(our underlining)

We noted that the PCC’s concern regarding this aspect of insight was again referred to at paragraph 55:

“Whilst the Committee acknowledged that dishonest conduct always raises concerns about deep seated personality or professional attitudinal problems, your history and the positive testimonials suggest this behaviour was out of character. You have made some admissions, have accepted some of the original PCC’s findings, and have engaged throughout the regulatory and High Court appeal processes. However, the Committee still does not have any explanation from you about why you chose to behave in this way and in the absence of such an explanation and a clear demonstration of your insight into your dishonest behaviour, there remains a residual concern that, if faced with a similar situation in the future, you may act dishonestly again.

(our underlining)

The PCC was satisfied that Dr Balachandra was “continuing to develop her insight into her misconduct. It imposed a sanction of two months suspension with a review stating that: “a period of suspension with a review would allow you more time to reflect on your behaviour and to satisfy a reviewing Committee that you fully accept your dishonest behaviour, the impact of that behaviour on the profession and the public and an opportunity to reassure a reviewing Committee that you will not behave dishonestly in the future.”

The PCC said that reviewing PCC may be assisted by, amongst other matters,

“A detailed reflective piece focusingon why your behaviour was dishonest, how your actions reflect on your own practice and reputation and their impact upon the profession, and how the public view dentists.

There is no indication on the face of the determination dated 25 June 2024 that Dr Balachandra gave formal evidence at the review hearing. The determination recites verbatim passages of a reflective statement dated 19 June 2024 she had provided to the PCC (and which she provided to the PLDP, and which is before us). What is clear is that counsel instructed by the GDC had, from the outset, taken a neutral approach. The effect of Dr Balachandra’s evidence before us was that she had answered some questions from the panel. We consider it unlikely that there was any forensic examination of Dr Balachandra’s evidence regarding her insight/attitude and/or remediation, whether in the context of the specific concerns that had been expressed by the PCC on 2 May, or otherwise.

In our view, the statement provided by Dr Balachandra to the PCC on 25 June did not really address the issues that the PCC had referred to on 2 May 2024. There is nothing in the determination that suggests that Dr Balachandra had made clear to the PCC on 25 June 2024 that her actual position was that she did not accept that she had acted dishonestly (– which is, essentially, her position in this appeal). Had that been the case, the conclusions reached regarding her insight and attitude to the matters found proved may, or may not, have been different. It is not, however, our role to decide, or even second guess, this: our task is to consider the current evidence relevant to the inclusion of Dr Balachandra to the DPL.

Our task is to redetermine the decision in the light of all the evidence before us. We consider that the real issue is whether Dr Balachandra is, or is not, suitable. In our view consideration of the efficiency ground under regulation 7(2) (g) is unnecessary. We say this because we consider that the core issue is whether Dr Balachandra lack qualities are essential for inclusion on the list. In our view the essential qualities include integrity i.e. whether the practitioner can be trusted to act with integrity and be completely frank and candid with the Respondent in the event that any issues arise.

Stripped to the very essentials the impact of the adverse findings by the original PCC was that Dr Balachandra acted dishonestly and with intent to mislead in the respects detailed in charges 18-20. We refer to the PCC decision on 2 May 2024 for its full effect. Amongst other matters, this was not a single episode. Dealing with the last events, the PCC in May 2025 specifically said that faced with a choice between owning up to what she had done before (or, in common parlance “coming clean”), Dr Balachandra chose to act dishonestly by sending the fabricated letters to NHS England in 2018 and to the GDC in 2019.

In this appeal Dr B advanced her case for inclusion to the list on the basis of her witness statement dated 2 July 2025. We find that this statement did not make clear that that her real position was that she does not accept that she had acted dishonestly in relations to the remitted charges. We agree that it is not a condition precedent to a favourable finding regarding her application for inclusion that Dr Balachandra should accept findings of the PCC without qualification. In our experience an application for inclusion can be indeed granted even in circumstances when the performer does not agree with factual (or related) findings of the regulator. What is, however, reasonably to be expected is that someone seeking inclusion to the DPL will be frank and candid about their actual position.

In our view it is startling that Dr Balachandra’s actual position only emerged in the course of cross examination. In answer to Mr Haycroft she gave many and various reasons as to why her actions were not dishonest. These amounted to a denial of the main facts found proved by the original PCC. In the event she did acknowledge that she had acted dishonestly in retrospectively changing patient records. We noted that this had, indeed, been part of the mitigation advanced by Mr Butler in May 2024 - see para 25 C102 above.

In our view in her statement in these proceedings at D167 at para 29 Dr Balachandra had attempted to minimise matters as found by the PCC when she sought to say that the proven dishonesty “… centred on a single episodeinvolving the creation and submission of retrospective and misleading records and letters.” We consider that this reflects a lack of insight regarding the impact of the facts proved. The remaining charges involved a deliberate and premeditated decision to dishonestly fabricate letters in 2017, the alteration of clinical records to be consistent with the fabricated letters, which course of action was perpetuated when the Appellant sent the fabricated letters to the Respondent in 2018 and to the GDC in 2019.

We considered all the evidence given by the Appellant in the round. In our view the findings made by the original PCC regarding charges 18 to 21 were very serious. Overall, we consider that Dr Balachandra has not yet truly absorbed the implications of the findings made against her by the PCC. It is one thing for a practitioner to say, openly and with candour: Although I do not accept the findings of the PCC (in part or in whole) I respect the decision and I fully understand the need for, and will abide by, the highest ethical standards in future. It is quite another for a practitioner to seek to rely on the findings of the PCC on 26 June 2025 that she is fit to practise when, as we find, she had not been transparent regarding her actual position before that body.

The overwhelming impression created by A’s evidence is such that we have no real confidence she has, as yet, absorbed the need to answer any questions that might need to be raised by the Respondent in future with frankness and candour.

At an early stage in cross examination Mr Haycroft asked Dr Balachandra if she had received any complaints since 2019. Dr Balachandra hesitated and then said that there had been a complaint. When asked by the judge she said that it was a complaint about private treatment provided by her. Mr Butler did not re-examine but later said in submissions that the complaint was at an early stage in the GDC process. We say straightway that the fact of a complaint, in and of itself, is not significant. It is a fact of life that dental practitioners will receive complaints. The complaint in question may, or may not, result in any further action. The fact is that the existence of a complaint that is being currently being considered by the GDC had not been mentioned before. If, as here, a practitioner, is relying on the absence of any issues of concern since 2019, it would be open and transparent to have mentioned in evidence in chief that there is a complaint currently being considered by the GDC. It is, perhaps, a small example. Overall, we consider that the evidence regarding this aspect supports that Dr Balachandra’s attitude or responses to those who regulate her is affected by what she wants the regulator to know.

We have considered the length of time since the events giving rise to the PCC findings. On the PCC findings the last act of dishonesty found proved was the fact that Dr Balachandran sent the copies of the fabricated letters to the GDC in 2019. (She had sent the same letters to the Respondent the year before). This was in the context of an ongoing investigation before the GDC. We agree that this is a long time ago in temporal context. In our view the time since the matter in question arose should be viewed in the context of current insight and attitude.

In our view the relevance of Dr Balachandra’s dishonest conduct between 2017 and 2019 and her responses in this appeal make it very difficult indeed for NHS England to have a relationship of trust and confidence with her. The Appellant has had the full opportunity to demonstrate to the Respondent that she can now be trusted. We recognise the dilemma faced by a practitioner who simply does not accept that the findings of her professional body were correct. The represents an undoubted challenge but it presents a binary choice: whether to be candid and state your position, or not.

We consider that Dr Balachandra’s approach to these proceedings and her oral evidence showed poor insight regarding the proven misconduct, and a very poor understanding of the impact of her conduct on a relationship that has to be based in trust and confidence.

As to remediation, the PLDP has expressed its view that Dr Balachandra had not provided a reflective statement that referred to the NHS context. In our view the statement provided in this appeal was not the product of reflection in the context of the NHS regulations. We bore fully in mind that the Appellant’s approach may well have been influenced by a somewhat legalistic approach to the real issues we have to decide. It is always a matter of concern to the Tribunal when this arises because witness statements should be in the witness’s own words. In our view Dr Balachandra’s witness statement is in the nature of a legal argument. The Appellant’s overall approach in her statement was to contend that the decision was unfair and duplicative because the PCC had already decided that she is “fit to practice”. Whether Dr Balachandra subscribes to this view because of her own beliefs, or because of advice given to her, matters not for immediate purposes. In our view, whatever its origin, her adoption of this attitude does not bode well for any future situation when the Respondent, in pursuance of its statutory duties, might need to make enquiry of the Appellant regarding the services performed by her as a performer included on its list.

Regulation 7(3) directs the decision maker, when deciding if there are grounds for the refusal of an application, to consider a range of matters, including, under subparagraph (d) “the relevance of that matter to the Practitioner's performance of the services which those included in the relevant performers list perform, and any likely risk to the Practitioner's patients or to public finances.” Leaving to one side the alteration of clinical records as proved, the PCC findings do not concern Dr Balanchandra’s performance of clinical services. We proceed on the basis that risk to patient safety is not engaged. However, we consider that risk to “public finances” is relevant. In our view this is not to be regarded as limited to the risk of inaccurate/mistaken claims for payment being made to the NHSBSA by Dr Balachandra in future. We say straightaway that we consider that this risk of mistaken claims now being made is now low. However, public finances are inevitably involved whenever the Respondent has to consider and/or investigate any complaint or concern raised about a performer on the list it regulates. This involves the use of resources which come at a financial cost to public funds, both direct and indirect.

The background appears to be that a case had been opened by the Respondent in 2009. It appears that a number of cases had been opened after 2017(C142) some of which may well have related to the matters then considered by the GDC. We do not have any real details of the concerns held, or any outcomes (save in relation to the PCC findings). It is not necessary for us to have this level of detail. We say this because it is in the very nature of the performance of primary care services in the NHS that, from time to time, issues will arise that require the Respondent to try and find out what has happened, and why. This is, indeed, the reason why it is so important that those tasked with the governance of the primary care services can implicitly trust what the practitioner says in response to any enquiry or issue arising.

The Appellant relies upon the various steps/processes she has taken to tighten practice and procedures regarding claims and correspondence with the NHS BSA, all of which are to be commended. Her case is that this should provide confidence that there is no risk of inaccurate/mistaken claims being submitted. We acknowledge that there has been no issue regarding the accuracy, or even the probity, of any financial claims made since the events which led to the GDC proceedings. Of course, this has to be viewed in the context that, as a matter of fact, the Appellant has not been included on the DPL since February 2023, except for a short period between February 2024 and May 2024. As we have said, however, we consider that the risk of inappropriate claims is low.

It is contended that Dr Balachandra has “remediated” the dishonesty proved re charges 18-21.In our view it is inevitably difficult to remediate findings of dishonesty. It is especially difficult to do so when, as it emerged in evidence, Dr Balachandra does not actually accept the PCC findings made. (As we have said she did, however, acknowledge in her evidence to us that her actions in retrospectively altering patient clinical records were dishonest). Her overall position is that she respects the findings of the PCC and she has remediated the issues. In our view the fact that the charges involved dishonesty (albeit discrete acts) over a period of about three years strongly suggests that attitudinal issues may be involved. This was, indeed, raised by the PCC at the hearing in early May 2024 as a relevant matter to be addressed, but, on the evidence before us, it was not addressed or considered by the PCC on 25 June 2024.

In our view attendance in a number of on-line courses over a short period in June 2024 does not, in and of itself, meaningfully address the issue of remediation. We consider that Dr Balachandra’s written feedback on what she had learned on these courses was, to say the least, brief and repetitive. The overall impression we formed is that the evidence of reflection on what she had learnt in these courses was, at best, superficial and, at worst, a self-serving exercise that “ticked the box” regarding the completion of courses to demonstrate “remediation” at the forthcoming hearing on 25 June.

In our view, the Appellant has had ample opportunity since the adverse PLDP decision in March 2025 to address all the issues regarding her suitability both up to, and even at, this hearing. This opportunity was significant because the Respondent in the course of these proceedings, had explained its concerns in detail. Dr Balachandra said in evidence that she had done a lot of CPD on NHS rules and regulations, and that she had carried out “deep reflection”. She did not provide any documentary evidence of any efforts she has made to consider the specific NHS context and these efforts has not been mentioned in her witness statement in July 2025. In our view, it is notable that, although the PLDP panel had commented on the absence of any personal reflections in the context of the regulations, the overall impact of the witness statement relied on by the Appellant dated 2 July 2025 was to criticize the Respondent’s approach, and to effectively seek to challenge that the Respondent has any role other than to adopt the views of the PCC regarding fitness to practice.

Standing back, we have considered all the matters raised before us in the round. In our view the evidence before us that is relevant to the assessment of Dr Balachandra’s candour, insight and attitude, is different to that considered by the PCCs in May and/or June 2024. Having taken into account all the matters referred to in regulation 7 (3) (a) to (d), we find that Dr Balachandra “is unsuitable” to be included in the DPL under regulation 7 (2) (b).

The exercise of the power to refuse to include an applicant who, as a matter of fact, is unsuitable, is discretionary. There is no power to impose conditions where it is considered that the practitioner is unsuitable - for very obvious reasons.

We proceed on the basis that the decision to refuse to include Dr Balachandra on the DPL under Regulation 7 (2) (b) represents an interference with her private life rights under Article 8 (1) of the ECHR which is sufficient to engage protection under Article 8 (2).

The Respondent has satisfied us that the decision made is in accordance with the law and is necessary in pursuit of legitimate public interest aims, namely, the integrity of the DPL and the maintenance of public confidence in the ability of the Respondent to regulate inclusion to the DPL.

In terms of proportionality, our task is to weigh the impact of the interference involved in our decision upon Dr Balachandra’s private life interests against the public interests engaged.

As matters stand Dr Balachandra owns and operates a practice where her dentist colleagues treat patients under the NHS. She is currently only treating patients privately. She wants to be included in the DPL because this will enable her to treat patients under the NHS. In this context the refusal to include her name on the grounds that she is unsuitable is of less impact that might otherwise be the case because she is able to practice her profession on a private basis and to earn her living. In effect, the impact of our decision upon her private life interests is that it will reduce or narrow the range/scope and/or number of patients that Dr Balachandra might otherwise treat if she were granted inclusion as an NHS performer. We recognise also that our decision has clear reputational implications which might have the potential to affect future career opportunities. We also took into account that there is a known shortage of NHS dentists and have weighed this countervailing public interest in the balance.

Having balanced all these matters the Respondent has satisfied us that the private life interests of Dr Balachandra are far outweighed by the fact that she is today unsuitable to be included in the NHS list for dental performers. In our view a well-informed and reasonable member of the public would rightly be concerned if a practitioner who had engaged in the misconduct found proved were to be re-admitted to the DPL in circumstances where her evidence before this Tribunal showed a continuing lack of candour and little or no meaningful insight. In our view our decision to refuse to include Dr Balachandra’s name on the DPL is the minimum step necessary to protect the public interests engaged in the context of the NHS regulations.