General Medical Council v George

Neutral Citation Number: [2009] EWHC 1460 (Admin) IN THE HIGH COURT OF JUSTICE QUEEN'S BENCH DIVISION ADMINISTRATIVE COURT Case No: CO/5208/2009 Royal Courts of Justice Strand, London, WC2A 2LL Date: 24 June 2009 Before: HIS HONOUR JUDGE MOLE (SITTING AS DEPUTY JUDGE OF THE HIGH COURT) - - - - - - - - - - - - - - - - - - - - - Between: GENERAL MEDICAL COUNCIL - and - DR PLAVELIL ABRAHAM GEORGE - - - - - - - - - - - - - - - - - - - - - (Transcript of the Handed Down Judgment of WordWave International Limited A Merrill Communications Company 165 Fleet Street, London EC4A 2DY Tel No: 020 7404 1400, Fax No: 020 7404 1424 Official Shorthand Writers to the Court) - - - - - - - - - - - - - - - - - - - - - Claimant Defendant Mr A Colman (instructed by GMC Legal Department) for the Claimant Mr M Forde QC (instructed by Weightmans, Solicitors) for the Defendant Hearing dates: 10th and 12th June 2009 - - - - - - - - - - - - - - - - - - - - - Judgment HIS HONOUR JUDGE MOLE (sitting as Deputy Judge of the High Court) JUDGMENT (Friday 12th June 2009) 1. 2. 3. 4. 5. 6. THE DEPUTY JUDGE: Yes, Mr Colman? MR COLMAN: My Lord, we are agreed on this suggestion. We thank your Lordship again for taking this matter in at short notice. We are conscious of the fact that your Lordship has a full list and, if your Lordship thought it appropriate, we have discussed the matter and see no reason why the judgment could not be handed down. THE DEPUTY JUDGE: That is a very kind offer. I do have a long list. What I could do is simply tell you what the result is and hand down the full reasons later. MR COLMAN: My Lord, we are both conscious of the fact that you came to this case extremely late and without being in possession of all the documents and then had to produce a judgment with, I think, less than two-and-a-half working days. Were your Lordship to hand down the judgment, I therefore have absolutely no objection to that course being adopted. THE DEPUTY JUDGE: Thank you. Since I have reached a view, it seems to me only fair that I tell you what that view is. What I would propose to do is simply, without dealing with the preliminaries, to go to my conclusions on the matter today. Then you will know exactly what I think and, in outline, why I think it. I may, if I am going to hand it down, express myself in a slightly more elegant way if necessary but I will not change the conclusion. (His Lordship then read the passage in the following judgment headed ‘Conclusions’ and there was argument as to costs. The full Judgment and decision on costs follows.) JUDGMENT 1. 2. 3. 4. This is an application by the General Medical Council for the yet further extension of an interim order of suspension under section 41A of the Medical Act 1983. The history of this protracted matter is helpfully set out in the judgment of Lloyd-Jones J, 6th of June 2008 ([2008] EWHC 1337 Admin.) The parties have commended it to me as succinct and accurate and I rely on it with gratitude. I shall start the history with the referral on the 21st of November 2001 of Dr George to the GMC by the Chief Executive of the Doncaster and Bassetlaw NHS Trust. Dr George had been working as a locum consultant paediatrician until he was suspended on the 14th of September 2001. The GMC was then informed by several other NHS Trusts of concerns about Dr George's performance. They are detailed in the witness statement of Andrew Owen. I note that two of the expressions of concern related to matters occurring after the referral. One of these instances again resulted in Dr George's suspension, this time by the South Staffordshire Healthcare NHS Trust in October 2002. In 2003 Dr George agreed to undergo a performance assessment. However, when he was invited to actually do so in February 2003, he refused. The matter was taken before the GMC's Referral Committee. On the sixth of March 2003 the Interim Orders Committee, as it then was, made the first Interim Order of Suspension. On the 9th of December 2003 Dr George was directed to undergo a performance assessment. He did not do so and the Court granted the first six-month extension on the 1st of September 2004. It was accepted in the court proceedings that Dr George was then fit enough to be assessed. Since then Dr George has maintained that on health grounds he is unable to undergo any assessment, including a health assessment. There have been a number of further extensions; on the 24 February 2005 for a period of 12 months; on the 28th February 2006 for a period of four months; on the 28th of June 2006 for nine months; on the 27 March 2007 for three months; on the 19th of June 2007 for six months; and on the 19th of December 2007 until 31 March 2008. On that occasion the matter came before Lloyd-Jones J and he lifted a stay, which had been granted pending judicial review proceedings, on the hearing before the Fitness to Practise Panel. He ordered that the proceedings before the Fitness to Practise Panel be resumed and extended the period of suspension for a period of three months to permit the hearing to take place before that Panel. On the 17th March 2008 by consent the order was extended until the 31st May 2008. 5. The matter came back before Lloyd-Jones J on the 6th of June 2008. He granted an extension of six months rather than the 12 months the GMC was seeking. It is instructive to turn to what Lloyd-Jones J said on that occasion: "5. When the matter came before the Fitness to Practise Panel in March of this year, that panel decided that it had no jurisdiction to decide the matter before it. The background to the matter was that, following difficulties in relation to the performance assessment, in 2005 the GMC had invited Dr George to undergo a medical examination and he declined to do so. That was a matter which was later pursued before the Fitness to Practise Panel on the basis that he had failed to comply with a reasonable requirement of the assessment team. In fact, as it emerged at the hearing in March 2008, there had been no such requirement made by the assessment team. All that had happened was that there had been an administrative requirement. On that basis the Fitness to Practise Panel concluded it did not have jurisdiction to deal with the matter. Furthermore, the Fitness to Practise Panel came to the conclusion that the allegations made against Dr George in relation to deficient performance had not been properly referred to that Panel, that they were not properly before the Fitness to Practise Panel and, again, it had no jurisdiction to deal with those matters. It is a very unhappy history. It appears on the face of 6. it that there have been many occasions on which Dr George has been uncooperative. It is also a history which does not reflect any great credit on the General Medical Council. The position has now been reached in which the General Medical Council, after a suspension of some five years of Dr George, still has to complete an assessment as to whether Dr George is fit to continue to practise. The point is made by Mr Colman on behalf of the GMC that there has been no substantive finding in respect of his fitness to practise and that the concerns about the defendant's professional performance remain unresolved. He says that it is now proposed to pursue the question of the defendant's fitness to practise by focusing on his health and the unresolved performance issues. In this regard he points to the fact that two of the bases on which fitness to practise may be found impaired under section 35C (2) of the Act are deficient professional performance and adverse physical or mental health. 7. On 18 April 2008, the Interim Orders Panel of the GMC considered the matter of the suspension. It expressed its concern about the defendant's health and performance it also expressed concern about the erosion of his medical knowledge and clinical skills which may have occurred since he last worked. It determined that it was necessary to maintain the order of suspension because the defendant could pose a real risk to patients if allowed to resume unrestricted practise and, it is said, would undermine the confidence that the public is In these entitled to place in the medical profession. circumstances, I am asked to grant a further extension of 12 months within which such further assessments and determinations may be concluded." After setting out the law the Judge continued: "10. I am very concerned in this case at the period of time which has passed during which a professional man has been prevented from practising his profession. He has been suspended for a period of five years. I have regard also to the fact that at the start of the suspension he was 60 years old. In the event that the suspension is lifted and he is allowed to practise again, it is going to be increasingly difficult for him to find a permanent post. Ms Bowron in her submissions has made the point that at his age it is most unlikely that he would ever again obtain a substantive post. The effect may be mitigated to some extent by the fact that he has suffered ill- health and may in any event have been unable to practise during parts of this period. Nevertheless, it is a very serious matter to prevent a man from practising his profession. However the GMC considers that there are real concerns as to the fit and as of this doctor to continue to practise and that is a matter of which the court has to give great weight. 11. The question is essentially whether the allegations made against the practitioner justify the prolongation of the suspension. I am satisfied that there is a clear need that the fitness of this doctor to practise should be investigated further by the GMC, both in relation to his previous performance and in relation to his current state of health. This further investigation is to my mind necessary in order for the protection of patients and the protection of the public and necessarily outweighs the prejudice which has been suffered and which will continue to be suffered by Dr George as a result of his suspension. It also outweighs the concerns that I have as to the very considerable delays which have occurred during the proceedings before the General Medical Council. 12. Given the unhappy position which has now been reached, I consider that it is incumbent on the General Medical Council to employ the utmost expedition in pursuing these concerns in carrying out the assessments and referring them to the appropriate panels, if that should be necessary, and in bringing this matter to a speedy conclusion. That is necessary not only in the interests of Dr George but also in the public interest and the public's confidence in the systems which are operated by the General Medical Council. 13. It is Dr George's duty as a member of the profession to cooperate fully with his professional body in the necessary further investigations and procedures. In considering the appropriate period of the extension, I proceed on the basis that Dr George will be required to cooperate fully with the General Medical Council. There is no evidence before me to support the view that he is by reason of his medical condition unable to comply with such reasonable requirements as May be made of him by the General Medical Council in that regard. 14. Having regard to all of these matters, I propose to grant an extension of six months. I consider that, on the assumption of cooperation by Dr George, it should be possible for the General Medical Council to complete the necessary procedures within that time. It would, of course, be open to the General Medical Council to make a further application to the court for a further extension should those procedures not have been completed within the period of six months. I express now my view that I very much hope that no such application will be necessary. If such an application is made, of course, it will be a matter for consideration by the judge on that occasion. However, it is my view that the court will on such an occasion need to be persuaded that the General Medical Council has pursued this matter with the greatest expedition. It seems likely that a court on any such future application would consider that any further extension would require compelling justification." 6. 7. The first thing to happen was that on the 9th of June, three days after that judgment, Dr George obtained a Med 4 sickness certificate. This certified that Dr George was unable to pursue his "occupation" for a year. Counsel has been able to decipher for me most, though not all, of the medical reasons written on that certificate. Whether or not getting this certificate was prompted by Lloyd-Jones J's paragraph 13 (above) it certainly did not bode well for the cooperation by Dr George with the GMC that Lloyd-Jones J assumed. After accepting that a fresh assessment team would be necessary, the GMC proceeded to make plans for an assessment in October 2008. Dr George's solicitors objected to any further assessment and on the 7th of October, 12 days before the first phase of the assessment was due to begin, they told the GMC that Dr George could not undergo an assessment because of his medical condition. The certificate was produced for the first time. The performance assessment began but under protest by Dr George's solicitors on various grounds. These grounds included the point that the arrangements under the 2004 Rules were invalid. The GMC considered this point and conceded it at the end of November 2008, adding another muddle to the history. On the 2nd of December the Registrar wrote to Dr George to let him know where the GMC stood. This was summarised as follows: “The GMC accepts that the arrangements for the performance assessment are invalid because it should be carried out under the 1997 Rules and not the 2004 Rules.” The GMC is not required to abandon the performance assessment forever. It is entitled to continue/restart it under the 1997 rules. However, in the light of the Med 4, it appears that Dr George is (and will probably remain) too ill to take part in the performance assessment until 9th of June 2009 at the earliest. Accordingly, the performance assessment will be put into abeyance although not abandoned. In the light of all the circumstances, and especially the Med 4, the Registrar is considering the health issues raised under rule 7(3) of the 2004 Rules with a view to directing (that) an assessment of Dr George's health be carried out in accordance with the schedule to those rules. The GMC will be inviting the High Court to extend the interim suspension order for a further nine months to cover the health assessment, and invites you to consent to such an extension.” 8. 9. A further six months extension was granted by consent on the ninth of December. That extension expires on the 13th of June 2009. Dr George's solicitors’ challenge the request for a medical examination on the basis that it was both unnecessary and unlawful. The arguments in that letter have been developed before me. 10. The Interim Orders Panel reviewed the interim order on the 24th of February 2009. The minutes of their consideration record the history and continue: "There is information before this Panel which suggests that Dr Abraham George's fitness to practise may be impaired. The concerns in question related to his ill health and the erosion of his medical knowledge and clinical skills which may have occurred since his registration was suspended in March 2003. The Panel has been provided with no information as to any steps the doctor has taken in order to keep his skills and medical knowledge up-to-date. The panel is of the view that if Dr Abraham George were to be allowed to resume unrestricted practise, he could pose a real risk to patients and could also undermine the trust that the public places in the medical profession and its practitioners. The Panel further considers that it would not be in his own interests to do so, given the unresolved concerns. The Panel is satisfied that, in all the circumstances, there may be impairment of Dr Abraham George's fitness to practise which poses a real risk to members of the public or may adversely affect the public interest or his own interests. Having balanced his interests and the interests of the public, the Panel considers that an interim order is necessary to guard against such a risk.” 11. It is as a result of that decision that this application is made. SUBMISSIONS 12. Mr Colman drew attention to the public protective function of the proceedings. The concerns that brought the Claimant to the attention of the GMC are serious and wide ranging. The GMC has sought to conduct a performance assessment but its progress has been delayed. True, the GMC is not blameless in that but it has pursued its purpose with determination despite problems on the way. By contrast, the longer matters have gone on, the more it looks as if Dr George is determined not to cooperate at all. As Mr Colman put it, if his goal was to avoid assessment he could hardly have done more to achieve that end. Mr Colman emphasised that the performance assessment was in abeyance, not abandoned. Dr George has now been out of practise for seven years. There is a real risk that he has lost old skills and failed to acquire the necessary new ones. The prejudice to Dr George’s interest is mitigated by the fact that if, indeed, he has been unable to follow his occupation, as the medical certificate says, then he can hardly have suffered significantly. He could not have worked anyway. The GMC are entitled to consider the health of a doctor as an obstacle to practise. The protective function is as important in such a case; it is quite unrealistic to suggest that questions of health can be left to the judgment of potential employers. 13. Mr Forde QC submitted that the failings and delays caused by the GMC should not be overlooked. The GMC seem to have had several changes of mind. Their points now seem to be the issue of ill-health and the issue of de-skilling. As to the former, that cannot or ought not to support a continued suspension. He drew attention to the witness statement of Mr Mitchell, which suggested that it is almost unprecedented for the GMC to rely upon physical ill-health alone as a basis for suspension. He suggests that this change of position is because a performance assessment would be based on allegations of such antiquity that they would now be unsustainable. Mr Forde submitted that therefore the matter must come down to the de-skilling issue. The question was whether Dr George's medical knowledge and clinical skills may have been so eroded over the past seven years that the continuance of suspension is justified. There was evidence in the witness statement that the Dr George has made efforts to keep himself up to date. In any event this was an issue properly left, like the question of Dr George's ill-health, to the usual investigations and the good sense of any prospective employer. THE LAW 14. In the case of the of the General Medical Council v Dr Stephen Chee Cheung Hiew [2007] EWCA Civ 369, the Court of Appeal gave guidance as to approach a court should take to an application under section 41A (7) of the Medical Act 1983. Lady Justice Arden said the time had come for the Court to work the various pieces of cloth provided by cases over the years into a useful garment. In paragraphs 26 to 33 she set out a number of principles. Lloyd-Jones J, in his turn, tailored that garment into a slim-fit version, which I shall adopt. He summarised the general principles as follows: "(1) The court has the power and the duty to consider whether any extension of time beyond the initial period set by the GMC is appropriate. Under the scheme, this exercise in decision making is to be performed by the court as the primary decision- maker. (2) The court has the power to determine that there should be no extension or that there should be the extension sought by the GMC or some lesser extension. In an appropriate case, the judge also has a power under section 41A (10) to terminate the suspension or to shorten the current period of suspension. (3) The criteria to be applied are the same as for the original interim order under section 401A (1), namely the protection of the public, the public interest and the practitioner's own interests. The court can take into account such matters as the gravity of the allegation, the nature of the evidence, the seriousness of the risk of harm to patients, the reasons why the case has not been concluded and the prejudice to the practitioner if an interim order is continued. (4) The onus of satisfying the court that the criteria are met falls on the GMC. The relevant standard is the civil standard. (5) The judge must reach his decision as to whether to grant an extension on the basis of the evidence on the application, which will have been examined with care. (6) The power to grant an extension and the power to make the orders set out in section 401A(10) represents the limit of the court's express powers in relation to interim measures. Parliament has not given the court power to determine in the first instance whether an interim suspension order or conditional order should be made. It has clearly taken the view that the GMC is better placed than the courts to decide such matters. (7) It is not the function of the judge under section 401A(7) to make findings of primary fact nor is there any threshold test to be satisfied before the court can exercise its power of extension. (8) The evidence on the application will include evidence as to the opinion of the GMC and the IOP or the Fitness to Practise Panel as to the need for an interim order. Appropriate weight will be given to that. All that is required is that the court should give that opinion such weight as in the circumstances of the case it thinks fit. (9) Finally, the function of the court is to ascertain whether the allegations made against the medical practitioner, rather than their truth or falsity, justify the prolongation of the suspension." 15. 16. I was also shown the General Medical Council (Fitness to Practise) Rules Order of Council 2004 and in particular the power of the Registrar under rule 7 to direct that an assessment of a "practitioner's performance or health be carried out". There had been a suggestion floated that the "or" was disjunctive; it had to be one or the other, it could not be both. However, Mr Forde did not pursue that point, conceding that it would be difficult to argue, given the public protective nature of the GMC's function. I am sure he is right about that. It is not difficult to imagine circumstances where a practitioner's performance and his health are closely related and it is important in the public interest to assess them both. There are powerful reasons for interpreting the provision that way and no evident reason for the contrary view. CONCLUSIONS 17. 18. 19. 20. 21. I have very much in mind the relevant matters as identified by the Court of Appeal in Hiew. It is very serious and a matter of great concern that a professional man should be subject to interim suspension for seven years. But the circumstances have to be borne in mind. I have no doubt that the GMC contributed, to a degree, to the delay. Equally I share the view of Lloyd-Jones J that great weight must be given to the concerns about Dr George's performance and his fitness in those terms to continue to practise. To my mind, it is simply unrealistic, in a public protective context, to suggest that the allegations against Dr George are of reducing weight because they are now becoming of some antiquity. At least it is unrealistic where the GMC has been seeking to pursue those concerns but has been unable to do so largely because Dr George has not been willing, or has not been able, to cooperate in a justified performance assessment. I ask myself what the GMC would or could do if it were faced with the situation where there were genuine and serious concerns about a doctor's fitness to practise but where the GMC were unable to undertake any assessment because of the doctor's long-term ill-health. On the arguments presented on behalf of Dr George, after the doctor in question had been ill long enough and out of practise for a substantial period of time, the GMC would have no justification, save for the de-skilling argument, for continuing to suspend him from practise. I would find that a very strange result. It seems to me that the answer must be that the question of performance assessment does not fade away; it may, perforce, remain in abeyance but it is a vital part of the background and has an important bearing on the reason why the GMC would be concerned about the state of the doctor’s health. To return to the specific case of Dr George, it is necessary to consider not only what is said on his behalf, but what actions he has taken. Unhappily, it is difficult to see that Dr George's actions can give any confidence that he has been or will be willing or able to cooperate with the GMC. Mr Justice Lloyd-Jones's assumption of cooperation was undermined within three days of his pronouncing it. So when I consider, on the evidence, the reasons why the case has not been concluded and the prejudice to the practitioner, those factors seem to me to deserve less weight than would otherwise be expected. Turning to the protection of the public and the risk of harm to patients, it seems to me that the GMC are entitled to be very concerned. I accept that the pace of change in medicine generally has been very fast and paediatric medicine is no exception. It is important for Dr George to keep up. It may be that a doctor can keep up through his own private efforts, even though he is not in practise, but it is by no means inevitable that he can. It might be thought to be a particularly difficult challenge for Dr George, who has been, for the course of last year, too ill to actually practise. The only way of knowing whether he has succeeded or not, it seems to me, is for him to be assessed. It is no answer to say that either his state of health or the state of his currency with modern medicine can be left to the assessment of local NHS employers. I accept the submission of Mr Colman that investigations into prospective locum appointments, a substantial part of Dr George's appointments in 2002 and 2003, may be considerably less rigorous and penetrating than investigations into an application for a substantive post with a NHS Trust. It is also true that no investigation at all is necessary if Dr George seeks to engage in private practice. In short, I agree entirely with the view of Lloyd-Jones J, set out in his paragraph 11, quoted above. Sadly, in the year that has passed since that view was expressed, the prospect that Dr George will cooperate with the GMC has receded and the reasons to be concerned about his medical skills have gathered force. I reluctantly conclude that there is really no alternative, balancing the considerations that I need to balance, to extending this interim order for yet another period. Nor do I see any reason for making that period less than the one sought by the GMC, namely 12 months. I therefore extend the order for a further 12 months. 22. 23. 24. MR COLMAN: My Lord, I have an application for costs. The court should already have the statement of costs earlier submitted that there is an additional copy for your Lordship and there is a supplementary application in respect of today's costs. The total amount is £4,524.75. 25. THE DEPUTY JUDGE: So the total is £4,524.75. 26. MR COLMAN: May I say to my learned friend, that includes some court costs for the application, the fee for the application, £400. Those costs would have to be incurred in any event, even if there were consent, because the order has to be lodged. So I mention that so that your Lordship can take that into account. 27. THE DEPUTY JUDGE: Do you want to say anything about that? 28. MR FORDE: My Lord, yes, that application is resisted for a number of reasons. My Lord, I make it clear that I do not pursue an application for Dr George's costs, it is a question of whether or not the Medical Protection Society Unit should hereby pay the costs of the General Medical Council. If we turn to the schedule of costs, first of all, for 10th June 2009. There are a number of items I would draw your Lordship's attention to. There would necessarily be a need for some attendance on those instructing me, not least because the application was made so late in the day. I did foreshadow this in my submissions earlier this week. As long ago as February of this year it was clear there would need to be an application to this court. Your Lordship has the Interim Order Panel's decisions of CA07. 29. THE DEPUTY JUDGE: There was delay. 30. MR FORDE: There always is, my Lord. The Society would certainly invite your Lordship, in terms of any costs order considered, to indicate the impropriety of that course. The reality of the situation is that Dr George was written to on 1st June and given until noon on 8th June, about a week. Those instructing me received the supporting documentation on 3rd June, last Wednesday. They ascertained my availability on the Friday. I received the papers at 4.50 pm on Monday. I advised by Tuesday. There was no opportunity to consult with Dr George as to an appropriate course of action because matters were left so late. 31. My Lord, that is a deplorable situation when one is dealing with the future of a professional person, or any person. Necessarily as Mr Colman has quite generously accepted, section 41 of the Medical Act 1983 (as amended) requires the High Court to scrutinise applications for extensions, the 18-month period being the maximum that the IOP can impose. There is a good reason, because the policy adopted suspends for lengthy periods of time. I would therefore submit that the first item of £116 would probably necessarily be incurred. More importantly, the next two items, the work on documents which total £1,781, must have been the time taken to prepare both particulars of claim and the lengthy witness statement. Both, in my submission, would necessarily have to have been prepared in support of the application. I cannot gainsay the attendance at the hearing and the travel. 32. 33. I am unsure as to when Mr Colman became involved. His skeleton is dated 8th June. I know not whether his brief fee had been incurred or sent at the cut off point, which was 12.00 noon on the 8th. If it had not been, the General Medical Council must be entitled to those costs. If it had been incurred, or for that part of last week, which I am sure Mr Colman will be able to tell you, then those costs would have been incurred in any event, as we were being given until noon on 8th June to consent to that course of action which is this proposal. Today's costs are in the relatively modest sum of £547.75. I could not resist that. The battle with the General Medical Council was lost and they attend upon your Lordship. The main items are therefore on the first place, 10th June, that item. We can agree the mathematics. It would be my submission that the first three items ought not to be allowed, plus the £400 court fee, would necessarily have been incurred and should be paid by the Society not by Dr George. The final matter is this. Your Lordship has placed some reliance on Mr Colman's submission and quite properly; no criticism is intended. But not only do locum posts potentially have a less rigorous system of assessment, but there is the potential for private practice with no investigation at all. You will recall the last matter was dealt with by Mr Colin Clarke. It does not appear as an argument in either the skeleton argument or the witness statements for the application, and to that extent, as far as your Lordship's judgment relies on those new matters, it would be my submission that we ought not be on this side responsible for the entirety of the General Medical Council's costs. My Lord I cannot put it any higher than that. 34. THE DEPUTY JUDGE: Do you want to come back? 35. MR COLMAN: Quite briefly; my learned friend asks whether my brief fee was incurred before the cut off point. It was not. 36. MR FORDE: I accept that. 37. THE DEPUTY JUDGE: Very well, I am going to assess costs summarily. I take into account and make a reduction on account of my disapproval of the very short notice that was allowed to those representing Dr George. It seems to me, since it was resolved in February to apply, it would be necessary to extend or ask for an extension. It was equally obvious in February, the Med 4 having been received by then, that there was no prospect of anything constructive happening. That is why it was necessary to have an extension. 38. It does seem, I am afraid, inexcusable for Dr George and his advisors to have been left with the very tight timescale that they were. There are also seems to me to be some force in what Mr Forde says about the degree of work that would have been necessary to do in any event in order to extend the matter even if there had been any consent order. This summary assessment is always something of a rough and ready judgment, and what I propose do to, to take account of both those matters, is to give the General Medical Council their costs assessed at £2,000. 39. MR COLMAN: Thank you my Lord. May I hand up a draft order for your Lordship's approval? 40. THE DEPUTY JUDGE: Thank you very much. What I propose to do, I shall hand down the written judgment. I shall simply do so through the court. No attendance will, of course, be necessary at all and it will be conveyed to you in the usual way, as soon as I get round to processing it into writing. 41. MR COLMAN: Thank you for dealing with the matter at such short notice. 42. THE DEPUTY JUDGE: Not at all. Thank you both for your helpful and interesting submissions.