Case No: 10780



Mr Christopher Limb                Chairman

Dr Mike Sheldon                        Professional Member

Mr Allan Lloyd             Lay Member






Appellant (GMC No: 2259480)








  1. Dr Rao practised as a general medical practitioner in Toxteth, Liverpool from 1982 until 2002 (there is a dispute which both parties agree is not of relevance as to whether the effective date was in April or June 2002) when he was removed from the List and an appeal dismissed.   By an application form dated 16th December 2002 Dr Rao applied to join the Supplementary List of Central Liverpool PCT.  Following meetings of the Medical Practice Committee on 17th and 30th July 2003 the PCT decided to refuse to include Dr Rao on the Supplementary List and notified him by letter of 6th August 2003.  By letter of 2nd September 2003 Dr Rao, acting by his solicitors, appealed such decision.  This is the hearing of such appeal.


  1. The Panel sat at the Thistle Hotel in Liverpool on 5th December 2003.  Dr Rao was represented by Mr Nicholas Peacock of Counsel together with his instructing solicitor Mr Cooper of Radcliffes le Brasseur.  The PCT was represented by Mr Gibbons, solicitor of Hill Dickenson.  We heard oral evidence from Dr Rau and Dr Pati on behalf of the Appellant.  We heard oral evidence from Dr Tierney on behalf of the PCT.  We had written evidence as contained in the FHSAA Enclosure List distributed to all parties, and in the form of written statements from the three witnesses who gave oral evidence.  The Notice of Appeal of Dr Rau referred to and thereby included in evidence four very substantial exhibits (over 600 pages in length) principally comprising all the material before the GMC Committee on Professional Performance (CPP).  We also had available the various determinations of the CPP and a full transcript of the most recent hearing of 25th June 2003. 


The Law

  1. The relevant regulations are the National Health Service (General Medical Services Supplementary List) Regulations 2001 made pursuant to provisions of the National Health Service Act 1977 and the Health and Social Care Act 2001.  Both parties agree that such are the relevant regulations and that the amended Regulations (Statutory Instrument 2003 No 2644) are not applicable to the present case – although there is no practically important difference between the regulations for the purposes of the issues between the parties.  The grounds for refusal are set out Regulation 6.


  1. The Tribunal may make any decision on appeal which the Trust could have made.  The appeal is by way of a re-hearing.


  1. The PCT grounds for refusal included grounds under both Regulation 6.1 and under Regulation 6.2.  By reference to Regulation 15 the Tribunal of its own volition raised with the parties the issue of whether there was jurisdiction to hear an appeal in relation to the decision insofar as it was made under Regulation 6(2).  It was agreed and ordered that the parties would submit written arguments upon such issue by Wednesday 17th December and our decision in such regard is set out later.  The Tribunal was requested by the Appellant and agreed to indicate its decision on the merits of the application in any event even if deciding there is a lack of jurisdiction in relation to the ground under Regulation 6(2).



  1. Dr Rao qualified in India and had various appointments in India until 1976.  He then had various hospital appointments in the UK from the beginning of 1977 until July 1980.  He practiced as a GP Locum between January and August 1980 and undertook GP training between September 1980 and August 1981.  He commenced practice as a principal single-handed general practitioner in Toxteth in April 1982. 


  1. In 1999 the first of what turned out to be several considerations of Dr Rao’s performance was commenced by the CPP. The first determination was on 23rd June 2000.  There was a finding of serious deficiencies in Dr Rao’s performance and various conditions were placed upon his registration. 


  1. There were further determinations on 10th January 2001, 31st August 2001 and 25th June 2003.  We shall refer to their findings and to the conditions imposed at greater length in the decision.


  1. In April or June 2002 Dr Rao was removed from the General Medical List.  He undertook periods of assessment and training with doctors approved by the local Director of Post Graduate Education (it being a matter of dispute between the parties as to whether there was a true training element) but such came to an end. Subsequent to removal from the General Medical Services List there was some training organised by Dr Rao personally with Dr Vithlani and Dr Tewari.  On 20th June 2003 there was a day of assessment organised by Dr Rao personally with Dr Pati. During the period since the first hearing before the CPP Dr Rao has taken various other steps by way of education. 


The issues/evidence

  1. There are four grounds upon which the PCT rely:

(a)   By reference to Regulation 4(2)(i) and 6(1)(c) the PCT say they are not satisfied with the references provided;

(b)   By reference to Regulation 6(1)(a) the PCT say that Dr Rao is unsuitable to be included in the Supplementary List.  They refer to the CPP hearings and findings and say that their response was “no prospect of a sufficient improvement in your clinical care abilities within a reasonable time frame”;

(c)   By reference to Regulation 6(1)(e) they say that there are grounds to consider that Dr Rao’s admission to the Supplementary List would be prejudicial to efficiency of the services which he would undertake;

(d)   By reference to Regulation 6(2)(a) they say that Dr Rao has not for three out of the last six months provided general medical services in its area or provided satisfactory evidence that he intends to provide services in its area.


  1. In his application (see in particular page 47 of the FHSAA enclosure list) Dr Rao provided the names of Dr Kumar and Dr Misra as his referees and enclosed references.  He also included the names of Dr Vithlani and Dr Tewari as recent references although not including any written references from them. 


  1. Dr Tierney gave evidence that in his role of medical adviser one of his jobs was the assessment of references.  He gave evidence that the test he used as to whether a reference was a “clinical” reference was whether it concerned knowledge, skills and attitude in the general practice context of consultation, prescribing and administration. 


  1. In his written statement Dr Tierney indicates in paragraph 7 that he did not consider the references of Dr Kumar and Dr Misra to meet the requirements “in that they do not relate to posts held recently for at least three months without a significant break”.  In his oral evidence he indicated that he also considered that they did not fulfil his definition of a “clinical” reference.  It was in such context that both Dr Vithlani and Dr Tewari were then contacted by the PCT and they provided letters which are at pages 60 and 61 of the FHSAA enclosure list dated respectively 27th March and 2nd April 2003.  Dr Tierney gave evidence both in writing and orally that he did not consider either of those letters to satisfy the requirement of a clinical reference.  He indicated that he telephoned each of them (on 4th June and on 2nd July) and read to them his own definition of a clinical reference.  He indicates that both indicated they could not give such a reference.  He accepted in response to questions from the Panel that he did not pursue the issue of the extent of clinical information that Drs Vithlani and Tewari could give at any length and in effect indicated that he simply put his definition to them and accepted their indication that they could not give a reference complying with such definition.  Also in response to a question from the Panel, Dr Tierney indicated that alternative references within the meaning of Regulation 4(2)(i) would not always have to be clinical references but the only examples he could give in such regard would be references from someone else within the practice such as a nurse practitioner. 


  1. The evidence of Dr Rao in relation to references was in effect that the four doctors whose names he had given should have been considered satisfactory in the context of his known position that he had not been in full practice within recent months and within the context of therefore being “alternative” referees.


  1. In relation to the issue of suitability under Regulation 6(1)(a) neither party sought to question the conclusions of the CPP.  Dr Rao’s Notice of Appeal contends (as did Mr Peacock in oral admissions) that this ground is altogether too vague.  In the notification letter of 6th August 2003 the PCT refer to the CPP hearing of 25th June 2003 as containing no evidence to assist.  We take the view that that is plainly intended to be an indication that there is no evidence to assist in concluding that there has been significant progress in relation to competence.  They also refer to the training process under Dr Mathie’s supervision having ceased on the basis of there being no prospect of a sufficient improvement within a reasonable time frame.  In essence Dr Rao through Mr Peacock contends it is illogical to rely upon a lack of progress when the CPP did not conclude that further time for training was not appropriate, and when Dr Rao had organised further training for himself. 


  1. The Panel had all read a very considerable volume of written evidence which had been before the CPP and which was the basis for their findings to which we have already referred.  Dr Pati confirmed his written statement that he had carried out a clinical assessment of Dr Rao’s consultation skills on 20th June 2003.  In cross-examination he accepted that he has not been in full time practice since 1998 and had ceased to be a GP trainer in 1995 when his appointment as trainer was “not renewed” due to “problems” with a trainee.  He accepted that an assessment on a single day was no more than “a snapshot” or “overall” view.  He confirmed that he was not aware of the precise conditions imposed by the CPP although in very general terms aware that conditions on practice had been imposed.  In answer to questions from the Panel he indicated that the forms of assessment he used were of unknown source.  He indicated that there was no process of feedback from patients.  He indicated that the forms used for trainees were more detailed and not comparable. 


  1. Dr Rao in his evidence in effect dealt with the first three grounds of refusal as one and the Panel agree that the evidence is inevitably and quite properly considered relevant to all grounds.


  1. The essence of Dr Rao’s evidence was that he had done all within this power to comply with the CPP conditions and to undergo training relevant to fulfil such conditions.  He did not question the conclusion of the CPP that there was seriously deficient performance.  Following the initial hearing there was a period when Dr Mathie appointed assessors who spent a considerable amount of time with Dr Rao.  Dr Rao felt that he had fully cooperated and had made progress and was willing to continue with the programme.  It was plain that there was some notable ill will between Dr Rao and Dr Mathie and possibly the PCT in general and Dr Rao felt that he had been unfairly treated and the assessment programme was ended.  It is accepted on his behalf that there was no obligation on the PCT to provide training.


  1. Dr Rao’s subsequent training sessions with Dr Vithlani were in the form of tutorials aimed at improving clinical knowledge and he says that be believed he profited from them.  The time he spent with Dr Tewari was also beneficial in Dr Rao’s view and enabled him to consider a far wider range of patients’ problems than he had come across in his own practice and enabled him to improve his skills of both consultation and clinical knowledge under the supervision and guidance of Dr Tewari. 


  1. It was not suggested by Dr Rao that Dr Pati undertook any form of training but simply an assessment.


  1. Dr Rao indicated that he had undertaken more general self education in terms of reading and attendance at courses and felt he had improved as a result.


  1. Dr Rao took formal tests in the form of the MCQ examination for GPs on two occasions and had failed on both occasions even if by a relatively narrow margin.  He appeared in his evidence to say that he should be given some leeway or particular understanding in such a context in comparison to younger trainees. 


  1. It was at some points of evidence and submissions put forward on behalf of Dr Rao that the CPP had accepted that there had been improvement at the time of the hearing in June 2003.  The relevant part of the Determination is “the Committee acknowledge and commend the efforts you have made to show that you have improved your clinical knowledge and skills in terms of the deficiencies identified.  However they do not have sufficient evidence to suggest that they could allow you to return to unrestricted practice”. 


  1. The way the case was originally put by the PCT in relation to “efficiency” was that inclusion of Dr Rao on the Supplemental List in the context of him receiving training from others on the list would be prejudicial to the overall efficiency of the PCT because of the resources and time involved.  The case of Dr Rao is that efficiency in this context is a reference to his own efficiency. 


  1. The Panel is able to look at the entirety of the evidence and potentially consider that matters of clinical competence can be considered of relevance to both suitability and efficiency.


  1. In relation to the final ground under Regulation 6(2) the relevant aspect is evidence of intention to provide services.  The essence of the PCT case is that such is not demonstrated on the basis that it is unrealistic to foresee it being achieved and that there is no reasonable prospect of sufficient training being successfully undergone and resulting in Dr Rao’s fitness to practice.  Dr Rao gave evidence that he intends to practice and has to demonstrate such intention.  The real dispute is not as to a genuineness of the intent but rather whether in principle the relevant issue is the intention per se or the existence of any reasonable basis to anticipate that the intention will be able to be fulfilled. 


Findings and Decision

  1. We shall deal with each of the grounds in order albeit there is some notable overlap particularly between the second and third grounds. We remind ourselves that this is a re-hearing and we approach the matter afresh in the same way as if this was an initial application rather than an appeal.  We remind the parties that we deal with all grounds but do so subject to the issue of jurisdiction with which we deal later in the Decision (paragraph 46 onwards).


  1. We accept that none of the references provided by Dr Rao reasonably satisfied the definition of a clinical reference.  We accept Dr Tierney’s definition of a clinical reference is a reasonable definition.  In our view the approach of the PCT to Regulation 4(2)(i) is over restrictive in the context of an Applicant who is unable to provide clinical references relating to two recent posts which lasted at least three months without a significant break.  In such situation the referees can by definition never give a clinical reference which is also related to recent practice.  References in such a context must be approached with a rather more open mind and in the context of the explanation for the inability to provide clinical references relating to recent posts. 


  1. Having indicated that in our view the Trust approached the matter too narrowly it is nevertheless our view that none of the four referees were in a position to give sufficient information or assessment to reasonably enable a conclusion that Dr Rao could be foreseen to practice in the future with adequate knowledge, skills and attitudes. 


  1. Where the references are not satisfactory in the foregoing sense – as opposed, for example, to where the references are positively unfavourable to the Applicant – it is particularly important to bear in mind that the grounds under Regulation 6(1) are discretionary grounds and not mandatory grounds for refusal.  It is particularly important in such a context to look for other evidence which does or does not have relevance to other relevant grounds for refusal such as the second and third grounds relevant in the present case. 


  1. The evidence relevant to the second and third grounds – suitability and efficiency – is in our view inextricably intertwined. 


  1. Certain introductory observations are relevant.  Dr Rao made plain in his written application that he was applying to be included on the list on the basis that he was “to be trained by a GP of standing”.  In other words he was applying to be on the Supplementary List in order to enable himself to be trained and satisfy the relevant authorities (namely the GMC and the PCT) that he could in due course be properly placed upon the General Medical List and/or upon the Supplementary List either without conditions or with conditions which would not prevent him from providing relevant services and earning a living thereby.  It is the understanding of the Panel as informed by its professional member and it was accepted by the representatives of both parties that the supplementary list is the appropriate list for trainees.  In other words a “normal” trainee who is at the beginning of his intended career as a general medical practitioner would apply to be upon the Supplementary List.


  1. We conclude that it is not an objection in principle that Dr Rao seeks to be placed upon the Supplementary List in order to enable him to undertake training.


  1. We have read the substantial evidence which has been before the CPP.  In such context we accept the findings of the CPP on 23rd June 2000 as based upon good evidence and in particular that against a background of shortcomings and a failure to cooperate with attempts to remedy such shortcomings the standard of Dr Rao’s performance was “seriously deficient” as set out in the Determination (pages 27 and 28 of the FHSAA enclosures). The CPP found that Dr Rao was seriously deficient in his ability to provide good clinical care including diagnosis and investigations, appropriate treatment and useful resources; in providing treatment of emergencies; in keeping up to date; in maintaining his practice; in maintaining trust and professional relationships with patients; in his fulfilment of the central role of the GP and communication with colleagues; and in relation to delegation and referral.  The CPP further specifically found that clinical management of certain conditions was poor; that he lacked familiarity with certain diagnostic equipment essential to effective general practice; that he had inadequate supplies of medication in his emergency bag; that in dealing with patients he had difficulties with conflict and with providing them with sufficient information; that his professional knowledge was seriously deficient and he performed poorly in tests of skills included in the second phase of his assessment; and that his practice premises were in various respects not of an acceptable standard.  The CPP further determined that they were “particularly concerned that these deficiencies persist despite the efforts which you and others have made in recent years to improve your standard of practice”.  They further expressly took account of assurance that Dr Rao would apply himself to remedying deficiencies and in such a context “have decided to give you one final opportunity to demonstrate that you are capable of achieving the necessary improvement”.  Such was the context in which conditions are imposed. 


  1. The conditions which were imposed in 2000 and subsequently varied on various occasions up to and including 20th June 2003 should be read in conjunction with this Determination.  The essence of those conditions has remained that Dr Rao can only work under supervision, must not undertake any work as a deputy or locum, must undertake assessment or examination, and must give the GMC full information as to all relevant matters. 


  1. It is plain that there were difficulties in the initial training and/or assessment by trainers appointed by the Regional Director of Post Graduate General Practice Education, Dr Mathie.  We do not think it is necessary for this Tribunal to decide where the fault lay in such a context but it appears plain that there was to some extent a breakdown of trust.  The subsequent decisions do not have any indication that the CPP received evidence which satisfied it that there had been any significant progress in terms of Dr Rao being likely to satisfy the Committee that his standard of performance would not in the future be deficient.  Thus on 10th January 2001 the conditions were varied “so as to make it easier for you to engage in remedial training whilst still registered” but also expressly found that “they continue to be concerned about your level of insight into the extent of your deficiencies”.  On 31st August 2001 they found that “you have made some limited progress in improving your practice” but areas of practice still requiring improvement were good clinical care, diagnosis, investigation and treatment, referring patients, record keeping, communication skills, and medical knowledge and they were still “concerned that you continue to lack insight into the level of the deficiencies in your practice and medical knowledge”.  In June 2003 the CPP accepted that Dr Rao had been unable to secure appointment enabling him to comply with their conditions, noted that he had of his own volition spent time undertaking tutorials with Dr Vithlani and observed consultations with Dr Tewari and had undertaken assessment with Dr Pati.  It was then stated that “The Committee acknowledge and commend the efforts you have made to show that you have improved your clinical knowledge and skills in terms of the deficiencies identified.  However they do not have sufficient evidence to suggest that they could allow you to return to unrestricted practice”.


  1. We have no hesitation in accepting that Dr Rao has made genuine attempts to improve his knowledge and skills.  We do not find that anything within the CPP determinations give proper grounds to conclude that he has in fact succeeded in improving his clinical knowledge and skills to a significant extent (albeit possibly making some limited progress).  We noted that Dr Vithlani, Dr Tewari and Dr Pati were not approved trainers.  Whilst we have no reason to question the goodwill of any of those three doctors or of Dr Rao neither the evidence before the CPP nor the oral and written evidence before ourselves appears to indicate any particularly good structure to the training that has taken place.  We were also concerned as to whether Dr Rao even today has insight into the deficiencies in practice and knowledge which have been identified by the CPP.  Dr Rao has taken and failed an MCQ examination.  As advised by the professional member of the Panel we take note that such is an examination meant to denote a basic level of knowledge and skills to enable safe practice.  It is not at an advanced level.  We were very concerned to note that Dr Rao in his evidence indicated the view that he should be given some leeway or indulgence because of his age and the number of years he has been practising.  We find such observations disturbing in the context of a test of a basic level of knowledge and skills.


  1. Both suitability and efficiency are issues in respect of which there is a discretion to include on the list or not.  We do not find that Dr Rao is suitable to be on the list without conditions.  We find that there is ample evidence that his knowledge and skills are deficient and remain deficient.  We find that he is unsuitable to be included on the list without conditions. 


  1. The provisions of Regulation 6(1)(e) do in our opinion plainly refer to the efficiency of Dr Rao’s services rather than the efficiency of the service of the PCT.  The deficiencies which have been found by the CPP and which we accept on the basis of the evidence before the CPP lead us to a conclusion that the admission of Dr Rao onto the Supplementary List without conditions would be prejudicial to the efficiency of the service he would undertake. 


  1. In relation to Regulation 6(2)(a) we accept as a matter of fact that Dr Rao has a genuine intention to provide medical services if he is permitted to do so.  That is in our opinion the relevant test.  The fact that he may or may not be allowed to provide such services and/or be allowed only with conditions is not evidence of lack of intent. 


  1. We indicated to both parties in the course of the hearing that we invited their submissions as to conditions that might be imposed if he were included in the Supplementary List. 


  1. In our opinion the PCT have an independent interest in the actual or future suitability and efficiency of Dr Rao in providing medical services in their area.  We accept the broad proposition put forward by Mr Gibbons that the PCT has its own obligations and duties as well as legitimate interest in relation to the service to be given to patients in their area and that in such a context it properly regulates its list to ensure that so far as possible the doctors upon it will be safe practitioners in whom the patients within the PCT area can properly place their trust and confidence.


  1. In the context of the findings we have already made it is appropriate in our opinion to allow the appeal to the extent of Dr Rao being admitted to the Respondent’s Supplementary List but to do so upon conditions.  We emphasise that the conditions are intended both to ensure the safety of patients in the sense in paragraph 42 indicated and in order to assist the legitimate interests of all interested parties.  The conditions will not in our view in any way materially impede the practical working of the CPP determinations.  They will recognise and encourage cooperation between Dr Rao and the PCT which is essential for the long term benefit of patients in the area. They will whilst not giving the PCT any power to prevent any steps taken by Dr Rao in the context of fulfilling the conditions of the CPP nevertheless give the PCT proper knowledge and information as to those steps which are being taken by a member on their Supplementary List and thereby enable them to commence any action they felt appropriate if they had legitimate concerns. 


  1. The conditions we impose are:

(a)   Dr Rao must comply with the conditions from time to time imposed by the GMC;

(b)   Dr Rao must forthwith inform the PCT of the identity of any group practice in which he is working;

(c)   Dr Rao must forthwith inform the PCT of the identity of any GP under whose supervision he is working;

(d)   Dr Rao must forthwith inform the PCT of when and what reductions in supervision are undertaken;

(e)   Dr Rao must inform the PCT of the mentor with whom he works;

(f)     Dr Rao must forthwith copy to the PCT his supervisor’s reports as submitted to the GMC, the results of any MCQ examination and the results of any simulated surgery exercise.


  1. For the avoidance of doubt we note and reiterate that it is the responsibility of Dr Rao to comply with the conditions imposed by the CPP and the conditions imposed by this Tribunal.  There is no obligation upon the PCT to arrange or fund training or other facilities to enable the conditions to be fulfilled.



  1. We are grateful to both parties for their submissions in relation to the issue of jurisdiction.  This is a matter which causes us concern and we are of the view that whichever view is taken the regulations (which for this purpose are the same in both their 2001 and 2003 form) merit further consideration.  The most obvious reading of the language of Regulation 15 is that in the absence of reference to Regulation 6(2) there is no right of appeal in relation to a decision based upon such ground. On the other hand the lack of an appeal would appear unjust in the context of the present case.  We recognise that many of the matters referred to under Regulation 6(2) are a matter of record in one form or another.  That is not the position so far as sub-paragraph (a) is concerned and particularly not so so far as the issue of intent to provide services is concerned.  In the present case and in other potential cases the issues referred to in sub-paragraph (a) are ones upon which there could be reasonably foreseen to be conflicting evidence and/or differing conclusions of fact upon the evidence.  It may well be that there are some cases arising in relation to some of the other sub-paragraphs where there can similarly be potential evidential conflict. 


  1. Mr Gibbons on behalf of the PCT says simply and straightforwardly that there is no reference in Regulation 15(1) to an appeal against the decision under Regulation 6(2) but only in relation to 6(1).  He contends that the wording is so clear that it cannot be read in any other way. 


  1. Mr Peacock on behalf of Dr Rao introduces his arguments by reminding us that Dr Rao was told by the PCT in the letter informing him of their decision that he had a right of appeal and that the issue of jurisdiction was raised by the Tribunal and not by the PCT.  He observes that the PCT position is “deeply unattractive” in the context of having initially indicated a right of appeal.  Mr Peacock continues to submit that Regulation 15 should be read as widely as possibly and that “decision” in Regulation 15(1) and 15(2)(a) should be read to include the entirety of the original PCT decision letter including that part of the decision reached by reference to Regulation 6(2).


  1. The first reason in support of such wide interpretation is said to be that Dr Rao is now out of time to apply for a judicial review.  We cannot accept that such can of itself be a reason for a particular interpretation as the interpretation must be the same whether or not the time for judicial review has or has not passed in a particular case.  Mr Peacock secondly urges that the relevant part of Regulation 6(2)(a) contains provisions which are not susceptible of easy documentary proof.  This is in substance the same observation as we have ourselves made in paragraph 46 above to the effect that whilst many of the matters referred to under Regulation 6(2) are in one form or another matters of record others (including the part relevant for this case) are not.  We accept that this is one reason to attempt to read Regulation 15 so as to include a right to appeal in the present circumstances but cannot of itself entitle us to act outside of any reasonable interpretation of Regulation 15 as opposed to attempting to give it the widest possible meaning in accordance with the overall spirit of the statutory and regulatory framework.  The reference by Mr Peacock to Article 6 of the European Convention on Human Rights and in particular to the entitlement to a fair hearing within a reasonable time by an independent and impartial Tribunal established by law is to the effect that the lack of an appeal both in the general circumstances of Regulation 6(2) and in the particular factual matrix of these proceedings would be unfair. 


  1. The Tribunal fully accepts for the reasons urged by Mr Peacock and upon a wider reading of the overall framework of the relevant Statute and Regulations that we should read Regulation 15 as broadly as possible and to give a right of appeal if the Regulation is capable of being so read.  It with some regret that we conclude that we are not able to interpret Regulation 15 so as to include a right of appeal against the decision by reference to Regulation 6(2) of the 2001 Regulations.  The wording is in our view plain that the only decisions which can be appealed are those under Regulation 15(2) and so far as relevant to this decision do not include a decision to refuse admission to the Supplementary List under Regulation 6(2).   We do moreover note that such distinction between discretionary and mandatory grounds is a reflection of Section 43D of the National Health Service Act 1977 as amended.  Sub-sections (3)(c) and (e) make specific reference to the Regulations providing for grounds upon which the Health Authority “may or must” refuse an application or suspend or remove a person from a List whilst sub-section (8) makes a specific reference to sub-sections (3)(c) and (e) insofar as they provide that the Health Authority “may” refuse an application or remove a person from a List and make no reference to provision for appeal when the Regulations provide that the Health Authority “must” take such action. 


  1. It therefore follows that despite what would otherwise have been our decision on the merits if there was unrestricted jurisdiction in relation to all the relevant grounds, we dismiss the appeal of Dr Rao on the basis that we have no jurisdiction to hear such appeal insofar as it relates to the refusal under Regulation 6(2).  The decision to refuse admission to the List by the PCT by reference to Regulation 6(2) is in such circumstances not a decision with which we have jurisdiction to interfere.



  1. The parties are reminded that they have rights of appeal pursuant to Section 11 of the Tribunals and Enquiries Act 1992.






Dated this    December 2003



Christopher Limb