Learning from real decisions · Case studies

Fitness to Practise Case Studies: Lessons From Published UK Decisions

Fourteen recent High Court and Court of Appeal decisions across doctors, dentists, pharmacists, nurses, allied health professionals and social workers, summarised in plain English, with what each panel decided, what the court did, and what made the difference.

Reviewed October 2026 against published judgments involving the GMC, GDC, GPhC, NMC, HCPC and Social Work England

14 real cases 6 regulators What made the difference

Short answer: published fitness to practise decisions show that outcomes rarely turn on the incident alone. Across these 14 cases, the factors that most often decided the result were the professional's insight, the quality and basis of their remediation, the context of the conduct, the time since without repetition, and whether the panel tested the evidence properly. Similar conduct led to very different outcomes depending on these factors. Courts generally defer to panels, but they do step in, in both directions, when a panel's reasoning goes wrong.

Key takeaways

Insight and remediation were decisive in more cases than any other factor, for and against the professional.
Remediation only counts if it rests on an honest account of what happened. Work built on denial carries little weight.
An attitudinal problem is not automatically a reason for removal. Courts distinguish entrenched attitudes from ones that have been addressed.
Context matters. Pressure, the advice of a senior colleague and missing support can change the sanction.
Allowing registration to lapse is not a way around a sanction where the risk continues.

How these case studies are written Each summary is written in our own words from the judgment published on the National Archives website, which is linked in the sources. We describe professionals by role rather than by name. The summaries are simplified and do not cover every issue in each case. They are for learning, not legal advice.

These cases sit alongside the case studies in our other guides, so none of them repeats a case used there. For how appeals work and the deadlines involved, see our guide to outcomes and appeals.

All 14 cases at a glance

4Reduced or quashed

8Upheld

2Increased

Case	Profession	Concern	Panel	Court
Thampi v GMC (2026)	Consultant obstetrician	Consent and communication	3-week suspension	No further action substituted
Mew v GDC (2026)	Orthodontist	Treatment not indicated, misleading claims	Erasure	Upheld
Mginah v HCPC (2025)	Biomedical scientist	Laboratory safety	Strike-off	Upheld
Hough v HCPTS (2026)	Advanced paramedic	Medicines and a false record	Strike-off	Upheld
Banks v SWE (2025)	Social worker	Lack of competence	12-month suspension	Upheld
Grzelczak v GDC (2026)	Dentist	Offensive emails	Erasure	6-month suspension substituted
Njoku v NMC (2026)	Nurse	Alleged racist bullying	12-month suspension	Findings quashed
Lambert-Simpson v HCPC (2023)	Practitioner psychologist	Social media posts	4-month suspension	Upheld
PSA v GPhC and Ali (2024)	Pharmacist	Offensive public remarks	Warning	Upheld
GMC v Gilbert (2025 and 2026)	Consultant surgeon	Harassment of colleagues	8-month suspension	Increased to 12 months with review
Khan v GMC (2024)	GP	Boundaries and prescribing	6-month suspension	Upheld
PSA v NMC and Graham (2025)	Nurse	Inappropriate conversations	Registration allowed to lapse	Strike-off substituted
Haroon v GMC (2025)	Doctor	Criminal conviction	Erasure	Upheld
Phillips v NMC (2025)	Mental health nurse	Conduct towards a patient, incomplete report	Strike-off	4-month suspension substituted

Clinical practice and competence

GMCSanction removed

A single delivery, nine years on

Thampi v General Medical Council [2026] EWHC 1036 (Admin)

What happened: In 2016, a consultant obstetrician performed an instrumental delivery. A tribunal found she had not obtained informed consent for forceps, had not adequately discussed alternatives or acted on the patient's stated preferences, and had told the patient "no, you can't have a c-section" without proper discussion.
Panel decision: Fitness to practise impaired. Suspension for three weeks.
Court decision: The impairment finding stood, but the court overturned the suspension and substituted no further action. The judge accepted that "no action is an unusual course following a finding of impairment" but found the positive factors in her favour "on any view, significant" (para 81).
What made the difference: An isolated event long ago, no repetition since, strong testimonials, and the disproportionate effect a suspension would have had on her career. The impairment finding itself was enough to mark the importance of consent.

GDCErasure upheld

Alternative treatment and promises to parents

Mew v General Dental Council [2026] EWHC 1116 (Admin)

What happened: A specialist orthodontist gave a non-mainstream treatment to two young children, starting at around five or six years old, and made claims to parents about correcting facial structure and breathing. A YouTube video he published was found especially problematic.
Panel decision: Treatment not clinically indicated; claims inappropriate and misleading; impairment found; erasure.
Court decision: Appeal dismissed. The court held that "the sanction of erasure was appropriate and proportionate to the seriousness of the breaches of professional standards identified" (para 150).
What made the difference: Vulnerable patients, claims beyond the evidence made to parents and the public, and a careful committee assessment of expert evidence that the court would not disturb.

HCPCStrike-off upheld

Laboratory safety checks that were not done

Mginah v Health and Care Professions Council [2025] EWHC 3300 (Admin)

What happened: In 2018, a biomedical scientist in histopathology did not run a control test after changing reagents, did not check airflow on a faulty downdraft bench, requested the same test twice on one sample, and did not take required weekly formalin readings over several months.
Panel decision: Misconduct and impairment found. Strike-off.
Court decision: Appeal dismissed. The court noted that he "had not undertaken any remedial work by way of training, mentoring or otherwise" (para 45).
What made the difference: Not the seriousness of each error alone, but continued denial of risk and no remediation at all. These are the kind of failings that targeted training and supervision can often address.

HCPCStrike-off upheld

A controlled drug, a junior colleague and a false record

Hough v Health and Care Professions Tribunal Service [2026] EWHC 743 (Admin)

What happened: An advanced paramedic with 30 years' experience faced two incidents. In 2018, with a child patient, he ignored specialist advice and kept inadequate records. In 2020, after a cardiac arrest, he directed a colleague who was not authorised to give midazolam, and then recorded that he had given it himself.
Panel decision: Misconduct, including dishonesty about the record; impairment; strike-off.
Court decision: All four grounds dismissed. The panel's view that he "lacked full insight" was "formed after a lengthy hearing" and was "pre-eminently a matter for the Panel" (para 99).
What made the difference: A false record covering an inappropriate delegation, a common attitudinal thread across two incidents, and limited insight.

Social Work EnglandSuspension upheld

When conditions are not enough for a competence case

Banks v Social Work England [2025] EWHC 1086 (Admin)

What happened: A newly qualified social worker did not pass her assessed first year with one council and then did not complete probation with a second. The concerns included inadequate assessments and reviews across several cases.
Panel decision: Fitness to practise impaired by lack of competence. A 12-month suspension rather than conditions of practice.
Court decision: Appeal dismissed. The panel had given sufficient reasons for rejecting conditions, and suspension was within the reasonable range.
What made the difference: The same failings recurred at two employers, even with support and supervision, and insight was limited. That made workable conditions hard to identify.

Conduct, communication and speech

GDCErasure replaced with suspension

Offensive emails, and remediation that counted

Grzelczak v General Dental Council [2026] EWHC 890 (Admin)

What happened: A dentist sent four racially offensive emails to staff at a dental laboratory in 2023. She admitted the facts in full at the start of the hearing.
Panel decision: Misconduct and impairment. Erasure.
Court decision: Sanction appeal allowed and a six-month suspension with a review substituted. The court said "Erasure would therefore have been excessive and disproportionate" (para 60), and found the committee had not properly recognised her later remediation, which included a structured professional behaviour programme, five relevant CPD courses and updated reflections.
What made the difference: Full admissions, targeted remediation and evidence that the attitude was not entrenched. Limited insight at one point in time is not the same as an irremediable attitude.

NMCFindings quashed

One complainant, and evidence that was not tested

Njoku v Nursing and Midwifery Council [2026] EWHC 2282 (Admin)

What happened: A nurse in charge on a hospital ward was accused by a newly qualified colleague of using offensive, nationality-based names and bullying her. The nurse denied everything. The colleague was the only direct witness.
Panel decision: Three charges proved, including discrimination and bullying. A 12-month suspension.
Court decision: Appeal allowed and the decision quashed, without a rehearing. The panel had not adequately analysed weaknesses in the complainant's account, including that she could not recall when or where events happened (para 65). The court said public confidence depends on findings reached "through a demonstrably fair, transparent and legally coherent process" (para 69).
What made the difference: Serious findings resting on a single account need careful, reasoned analysis. Given the time that had passed and the suspension already served, the court decided a rehearing would not be fair.

HCPCSuspension upheld

Posts in a "private" group

Lambert-Simpson v Health and Care Professions Council [2023] EWHC 481 (Admin)

What happened: A practitioner psychologist posted several items in a Facebook group of about 22 people that he believed was private. Three were found inappropriate and offensive, including one referring to a client, and one was found racially motivated.
Panel decision: Misconduct and impairment. A four-month suspension.
Court decision: Appeal dismissed. A private audience or an intention to be humorous did not prevent the racially motivated finding. HCPC standards require you to "use all forms of communication appropriately and responsibly, including social media and networking websites".
What made the difference: A reference to a client and a racially motivated post. A small or closed audience does not make content private in a regulatory sense.

GPhCWarning upheld

Unplanned remarks, years without repetition

Professional Standards Authority v General Pharmaceutical Council and Ali [2024] EWHC 577 (Admin)

What happened: A pharmacist made four unscripted remarks at a public rally in 2017. A committee found two of them antisemitic and offensive, and two offensive.
Panel decision: Impairment found. A warning, rather than suspension or conditions.
Court decision: The PSA appealed, seeking a heavier sanction. The appeal was dismissed. The committee had been right to regard as relevant "the fact that the comments were not premeditated and the circumstances" (para 76), as well as genuine remorse and six years without similar conduct.
What made the difference: The question was what sanction was needed at the time of the decision in 2023, not in 2017. Sustained good conduct since the event carried real weight.

Boundaries and relationships

GMCSanction increased

Harassment of colleagues over many years

General Medical Council and PSA v Gilbert [2025] EWHC 802 (Admin); GMC v Gilbert [2026] EWCA Civ 53

What happened: A consultant surgeon was found to have sexually harassed and made racist remarks to six colleagues between 2009 and 2022.
Panel decision: Impairment. An eight-month suspension with no review hearing.
Court decision: The High Court substituted 12 months' suspension with a review. The GMC and PSA then appealed for erasure, and the Court of Appeal dismissed that appeal. It said the decision "should be based on an evaluation of the overall gravity of the matter", not "counting how many factors out of ten were present" (para 62), and noted that a later review tribunal had found him no longer impaired after "comprehensive" insight and remediation work.
What made the difference: The tribunal found the misconduct capable of remediation, and later events bore that out. Sanctions guidance is applied as a whole, not as a score sheet.

GMCSuspension upheld

Prescribing for someone close

Khan v General Medical Council [2024] EWHC 1330 (Admin)

What happened: A GP in a personal relationship with a vulnerable patient prescribed for him on three occasions and accessed his clinical records on 19 dates over several months.
Panel decision: Misconduct and impairment. A six-month suspension.
Court decision: Appeal dismissed. The court referred to GMC prescribing guidance that "wherever possible, you must avoid prescribing for yourself or anyone you have a close personal relationship with", and treated the prescribing and record access as part of a sustained course of conduct.
What made the difference: A vulnerable patient, repeated record access and prescribing over months, with limited insight and remediation at the time of the hearing.

NMCStrike-off substituted

Lapse is not a way out

Professional Standards Authority v Nursing and Midwifery Council and Graham [2025] EWHC 3132 (Admin)

What happened: A nurse had inappropriate conversations with a patient and a colleague on disturbing topics, continuing with the colleague after being told it upset her. He was suspended, and at the review the panel allowed his registration to lapse with impairment recorded.
Panel decision: Lapse with impairment, rather than strike-off.
Court decision: PSA appeal allowed and a striking-off order substituted. "The decision to allow registration to lapse was not a decision that was reasonably open to the Panel following the NMC guidance" (para 51).
What made the difference: Limited insight and little progress during the suspension. A wish to leave the profession did not reduce the need for a sanction that reflected the continuing risk.

Outside work, and conduct under pressure

GMCErasure upheld

Remediation built on denial

Haroon v General Medical Council [2025] EWHC 2619 (Admin)

What happened: A doctor was convicted in 2024 of controlling or coercive behaviour towards his wife and received a suspended prison sentence.
Panel decision: Impairment by reason of the conviction. Erasure.
Court decision: Appeal dismissed. The court said his denial "is not in itself a ground for erasure but the practical effect is that his remediation work has been undertaken on an inadequate basis" (para 80).
What made the difference: You can disagree with a conviction, but a panel must work from it. Remediation that rests on denying what a court found cannot show reduced risk.

NMCStrike-off replaced with suspension

A bad morning, and the advice of a senior colleague

Phillips v Nursing and Midwifery Council [2025] EWHC 2993 (Admin)

What happened: In 2022, a mental health nurse came in to cover a short-staffed ward on the morning she learned a close relative had had a stroke. During a medication round she insulted a patient, threw items and pushed her twice, all witnessed and on CCTV. She told her team leader straight away, who said she would complete the incident report but leave out the push, and the reports omitted it.
Panel decision: Most charges proved, including dishonesty about the reports. Strike-off.
Court decision: Appeal allowed. The court found the panel had misjudged the seriousness of the dishonesty in context, overestimated the risk of repetition, and not considered that no occupational health support or workplace remediation had been offered. It substituted four months' suspension and said she should have a course of counselling with a clinical psychologist during it.
What made the difference: Immediate disclosure to a senior colleague, the colleague's direction about the report, a clean record and missing support. Context does not excuse conduct, but it shapes the sanction.

Reading decisions yourself

Panel and tribunal decisions are published by each regulator or its tribunal service, usually for a set period, and court judgments on appeal are published permanently. Reading decisions in cases like your own is one of the best ways to understand how panels think.

Where	What you will find
MPTS hearings and decisions	Medical practitioners tribunal and interim orders decisions for doctors
NMC hearings and sanctions	Monthly lists of hearing outcomes, with full reasons for nurses, midwives and nursing associates
HCPTS hearings	Searchable hearings and outcomes for the 15 HCPC professions
Dental hearings decisions	GDC practice committee decisions for dentists and dental care professionals
GPhC hearings	Hearings and determinations for pharmacists and pharmacy technicians
Social Work England hearings	Hearing outcomes for social workers in England
National Archives Find Case Law	High Court and Court of Appeal judgments on fitness to practise appeals

Read the impairment and sanction sections first. They show what the panel saw as the remaining risk, and why.
Look for the words about insight. Phrases like "limited insight" or "developing insight" usually explain the outcome more than the facts do.
Note what evidence was offered. Reflections, training, testimonials and work references are often listed and weighed.
Remember each case is different. A decision shows how a panel reasoned on its own facts. It does not predict the outcome of yours.

Seven lessons from the 14 cases

Insight and remediation decide more cases than the incident. Compare the dentist whose erasure became a suspension after structured remediation with the biomedical scientist who did none. Our guide to insight explains what panels look for.
Remediation must rest on an honest account. Work built on denying what a court or panel found carries little weight, as the doctor convicted of coercive behaviour found.
Attitude is remediable unless it is entrenched. Courts distinguish an offensive episode that has been addressed from a fixed attitude that has not.
Time without repetition counts. The pharmacist's six years and the obstetrician's nine years of safe practice shaped both outcomes.
Context can move the sanction. Pressure, a senior colleague's direction and missing support changed a strike-off to a suspension.
Panels must test the evidence. Findings resting on a single account need reasoned analysis, and courts will quash them if it is missing.
There is no shortcut out of a sanction. Lapse instead of strike-off, or a sanction reached by counting factors, will not survive an appeal where the risk continues.

If you are building remediation for a concern like those above, our remediation course supports a structured plan, and our guide to evidence of remediation explains how to present it. A course is one part of the picture. Panels look for reflection and changed practice too.

Frequently asked questions

Where can I read fitness to practise decisions?

Court judgments on appeals are published on the National Archives Find Case Law website. The MPTS, NMC, HCPTS, GDC dental hearings service, GPhC and Social Work England each publish panel decisions on their own websites, usually for set periods.

Do courts often overturn fitness to practise decisions?

Courts give panels significant deference, especially on findings based on live evidence. But they do intervene where reasoning is flawed, in either direction. In this set, four professionals had sanctions reduced or findings quashed, and two had sanctions increased.

Can a sanction be increased on appeal?

Yes. The Professional Standards Authority, and in some cases the regulator, can appeal a decision it considers insufficient to protect the public. Two cases here ended with heavier sanctions.

Does showing remediation guarantee a lower sanction?

No. Remediation is weighed with the seriousness of the conduct and other factors. But in several of these cases, its presence or absence was decisive.

Can racist or offensive comments lead to removal?

They can. But courts have distinguished entrenched attitudes from conduct that has been genuinely addressed. In one 2026 case, erasure was replaced with a six-month suspension because of full admissions and targeted remediation.

Are social media posts in a private group treated differently?

Not necessarily. In one HCPC case, posts in a small Facebook group still led to a suspension, including a finding that one post was racially motivated.

Can I avoid a sanction by letting my registration lapse?

Not where the risk continues. In 2025, the High Court replaced a decision to allow a nurse's registration to lapse with a striking-off order.

Primary sources

15 court judgments