Registrant: [name] · Registration number: [number] · Regulator / case reference: [reference] · Interim Order hearing date: [date] · Prepared by: [name]

SKELETON SUBMISSIONS ON BEHALF OF THE REGISTRANT

A. The test

An interim order of suspension or conditions of practice can only be made (i) for the protection of the public and / or (ii) where it is otherwise in the public interest to do so. No determinations of fact are made at this stage; the exercise is purely risk-based.

Before making any such order the panel must be satisfied that it is necessary to do so. The panel is reminded that this represents a high bar.

B. The cogency-of-evidence standard

It is a settled principle that, in every case, the panel must ask itself precisely why it is said to be necessary to impose an interim sanction on the registrant. If the case is that an order is necessary to protect patients, there must be an intense focus on precisely how and why the evidence demonstrates that patients may be at risk and how serious that risk is. A case where patients can be shown to have suffered harm will have more potency than a case where there is very limited or no evidence that any patient has come to harm. Even where there is cogent evidence that a patient is at risk, a suspension will not usually be justified unless the imposition of conditions cannot reasonably protect patients from that risk.

A useful sanity-check question, drawn from the established principles, is: would it be acceptable for the panel not to suspend in a case of this kind if at the end of the day the charges are proved and the guilt of the registrant is established? The modern emphasis is on necessity and on risk-thinking rather than outcome-thinking.

It is well established that asserting “some limited risk” to a patient from continued unrestricted practice is insufficient. The panel must engage with how and why the evidence demonstrates the risk and how serious it is.

It is also well established that an interim order on public interest grounds is only justifiable in a relatively rare case.

C. The general principles applied to this case

Drawing the principles together, the panel is invited to apply each of the following in the order set out, on the facts of this case:

1. An interim order should only be imposed if it is necessary for the protection of the public; there is a high bar that needs to be surmounted.
2. Considerations of the protection of the public and the wider public interest grounds are distinct and need to be considered separately.
3. There must be features of the case which mean that matters are so serious that it is justifiable to restrain the exercise of professional skills by a registrant at a stage when the allegations are unproven.
4. There needs to be an intense focus on precisely how and why the evidence demonstrates that patients may be at risk and how serious that risk is.
5. If some form of order meets the necessity test, the tribunal must be satisfied that no lesser form of order can be justified.
6. There should be no such thing as a “standard set of conditions”. The necessity test has to be satisfied with regard to each condition, on the facts of each case.

D. The evidence in this case

The regulator must establish, by reference to the material before the panel, that there is cogent evidence of a specific risk. The evidence must be carefully scrutinised as to how and why patients are said to be at risk.

[Apply to the facts — identify the evidence relied on, and the gaps in it. Examples: no contemporaneous clinical records; reliance on anonymous “concerns”; no Datix; rota records contradict the timeline; no expert opinion served; employer has not suspended; no other patients identified.]

[Identify the absence of harm where applicable. A case where patients can be shown to have suffered harm will have more potency than a case where there is very limited or no evidence that any patient has come to harm.]

E. Necessity is not made out

Applying the high bar, necessity for an order on protection-of-the-public grounds is not made out on this material.

On public interest grounds, this is not one of the “rare” cases for which an interim order on that basis is reserved. [Identify the features of the case that take it out of that category.]

F. In the alternative — least restrictive option

If, contrary to the registrant’s primary submission, the panel finds that some restriction is necessary, the panel must impose the least restrictive option that meets the risk.

Suspension will not usually be justified unless the imposition of conditions cannot reasonably protect the public.

[Identify proposed conditions, each one drafted to address a specific identified risk. Avoid pre-empting findings on the substantive case.]

Each condition must independently surmount the necessity test. There is no such thing as a “standard set” — each condition must be earned on the facts.

G. Period of the order

Any order should be for the shortest period reasonably necessary, with an express review at the earliest realistic point [propose date].

H. Conclusion

The panel is invited to:

(a) Refuse to make any order; or, in the alternative,

(b) Make an order limited to specific conditions of practice [as set out]; and

(c) Direct the earliest practicable review.

Signed: [name] · Counsel / Solicitor: [name] · Date: [date]

Principles checklist — quick reference

• Cogency — the evidence relied on must be cogent; assertion is not enough; intense focus is required on the precise risk.
• Sanity check — would it be acceptable not to suspend if the allegations were ultimately proved? Useful backstop, but necessity and risk-thinking dominate.
• “Some limited risk” — insufficient; the panel must engage with the seriousness of the risk in detail.
• Necessity threshold — the order must be necessary, not merely prudent or reassuring; a high bar.
• Statutory grounds — protection of the public, public interest, and (where applicable) the registrant’s own interest are distinct grounds and must be considered separately.
• Public interest — an interim order on this ground is only justifiable in a relatively rare case.
• Least restrictive — if any order is necessary, conditions are preferred to suspension where conditions can reasonably meet the risk.
• No “standard set” of conditions — each condition must independently satisfy the necessity test.

[END OF TEMPLATE]