Case Commentary: R (on the application of Sheila Adam) v The General Medical Council  EWHC 3378 (Admin)
This case raises an interesting distinction between medical and managerial responsibility for medical practitioners facing regulatory proceedings and what professional conduct should, or should not, be capable of amounting to misconduct, depending on the person's role and responsibility and proximity to the clinical care or subject matter of the complaint.
In this case, it was suggested that it was Professor Keogh's duty or responsibility as a doctor to ensure that clinical concerns or complaints were properly investigated in relation to one particular patient from his position of Medical Director of the NHS, even if only by delegating Dr Adam's email to a colleague to answer rather than him being personally involved. This was rejected; it being about managerial decisions rather than clinical ones and that an obligation could not simply be imposed by the sending of an email.
As Mr Justice Edis commented, the GMC had to grapple with the extent to which alleged failures in a management role could adversely impact on Sir Bruce's fitness to practice as a doctor.
Clearly there are cases where failures of practitioners in management roles will be capable of amounting to misconduct leading to their fitness to practice being impaired, such as Nurse Managers of care homes or Dentists who are practice principles, if their actions or omissions lead to patient care being compromised by other staff members. However the defining feature will be proximity to the failures leading to professional responsibility of the practitioner in a managerial capacity. Here Professor Keogh was simply too far removed.
It is noted that the referral against Dr Mitchell, the Medical Director of NHS London, is still being considered afresh under Rule 4, so it will be interesting and useful to know the outcome of that case, which might prove instructive on how proximate a professional person has to be in order to be held to have some responsibility for such matters in regulatory proceedings.