When does delay in fitness to practise proceedings become unfair? High Court considers seven-year NMC case

The High Court’s decision highlights the importance of clinical justification, informed consent and professional boundaries, with practical lessons for doctors and other regulated healthcare professionals.

A recent High Court judgment has underlined the potential fitness to practise consequences when a healthcare professional’s actions during a patient examination cannot be adequately justified by the clinical need.

In General Medical Council v Sathyanath [2026] EWHC 2479 (Admin), handed down on 30 September 2026, the High Court allowed an appeal by the General Medical Council (GMC) against a tribunal decision that had found serious misconduct by a GP but concluded that his fitness to practise was not impaired.

The case concerned an intimate examination during a consultation in September 2022. The Medical Practitioners Tribunal had found that the doctor placed his hand inside the patient’s underwear and brushed it over her pubic bone region. It also found that he had failed to offer a chaperone or obtain appropriate consent. However, the tribunal had concluded that the conduct was clinically indicated and had not been sexually motivated.

The High Court found that the tribunal had approached the question of clinical justification incorrectly and that its finding on sexual motivation was also wrong. The decision on impairment was set aside, and the relevant issues were remitted to a differently constituted tribunal for reconsideration.

Importantly, the High Court did not make a final finding that the doctor had acted with sexual motivation. That question, together with the relevant issues of misconduct and impairment, remained to be determined by the new tribunal.

Although the case arose from a doctor’s conduct during an intimate examination, its lessons extend more widely to healthcare professionals whose work involves physical examinations, patient contact, consent and professional boundaries.

When does delay become a legal issue?

The legal framework considered by the High Court derives from the right to a hearing within a reasonable time under Article 6 of the European Convention on Human Rights.

In considering the impact of delay, the Court applied the approach in Okeke v Nursing and Midwifery Council [2013] EWHC 714 (Admin), which requires consideration of the length of the delay, the complexity of the case, the reasons for the delay, the conduct of the parties and the consequences for the fairness of the proceedings.

Importantly, the Court recognised that a stay of proceedings for delay should only be imposed in exceptional circumstances. The registrant must establish, on the balance of probabilities, that the delay has caused such serious prejudice that a fair hearing can no longer take place.

The assessment is not simply about the number of years involved. It is about what has happened during those years and the effect on the ability to determine the allegations fairly.

For example, lengthy delays may create difficulties where:

• Witnesses have become unavailable or their recollections have materially deteriorated.

• Relevant records, documents or other evidence have been lost or destroyed.

• The registrant’s ability to obtain evidence or properly challenge allegations has been compromised.

• The passage of time has materially prejudiced the ability to present an effective defence.

• The proceedings have become oppressive or their continuation would otherwise offend the interests of justice.

The High Court’s judgment is particularly interesting because it acknowledged that the case was not especially complex and that some of the delay was attributable to shortcomings in case management. Nevertheless, it concluded that the available evidence remained sufficient to permit a fair determination.

The Court also distinguished the circumstances from Okeke, where a delay of approximately four and a half years had resulted in a breach of Article 6 rights. The different circumstances and consequences of the delay were material to the outcome.

A wider regulatory problem

The issue is not confined to the NMC. Delays in fitness to practise investigations and proceedings have been repeatedly identified by the Professional Standards Authority (PSA) as a concern across the healthcare regulatory landscape.

In its 2024/25 Annual Report, the PSA reported that seven of the 10 statutory healthcare regulators it oversees had failed to meet Standard 15 of its Standards of Good Regulation, which concerns the timely progression of fitness to practise cases. The PSA specifically identified the time taken to complete cases as the primary reason for the failure.

What does this mean for registrants and regulators?

The judgment does not establish that a seven-year investigation is acceptable, nor does it create a period beyond which regulatory proceedings automatically become unfair.

Instead, it reinforces the need for a fact-specific assessment of the consequences of delay.

For registrants, the important distinction is between demonstrating that proceedings have taken an unreasonable length of time and establishing that the delay has caused identifiable prejudice. An application to stay proceedings will need to address the actual impact on the fairness of the case, rather than relying solely on the chronology.

Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.  Some content may have been generated by AI tools.